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Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India
OBJECTIVE: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. METHODOLOGY AND RESULTS: We identified definite cases of CNS...
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Formato: | Texto |
Lenguaje: | English |
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Medknow Publications
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924508/ https://www.ncbi.nlm.nih.gov/pubmed/20814494 http://dx.doi.org/10.4103/0972-2327.64635 |
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author | Ramesha, K. N. Kate, Mahesh P. Kesavadas, Chandrasekhar Radhakrishnan, V. V. Nair, S. Thomas, Sanjeev V. |
author_facet | Ramesha, K. N. Kate, Mahesh P. Kesavadas, Chandrasekhar Radhakrishnan, V. V. Nair, S. Thomas, Sanjeev V. |
author_sort | Ramesha, K. N. |
collection | PubMed |
description | OBJECTIVE: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. METHODOLOGY AND RESULTS: We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000–2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy). CONCLUSIONS: Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians. |
format | Text |
id | pubmed-2924508 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Medknow Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-29245082010-09-02 Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India Ramesha, K. N. Kate, Mahesh P. Kesavadas, Chandrasekhar Radhakrishnan, V. V. Nair, S. Thomas, Sanjeev V. Ann Indian Acad Neurol Original Article OBJECTIVE: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. METHODOLOGY AND RESULTS: We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000–2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy). CONCLUSIONS: Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians. Medknow Publications 2010 /pmc/articles/PMC2924508/ /pubmed/20814494 http://dx.doi.org/10.4103/0972-2327.64635 Text en © Annals of Indian Academy of Neurology http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Ramesha, K. N. Kate, Mahesh P. Kesavadas, Chandrasekhar Radhakrishnan, V. V. Nair, S. Thomas, Sanjeev V. Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title | Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title_full | Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title_fullStr | Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title_full_unstemmed | Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title_short | Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India |
title_sort | fungal infections of the central nervous system in hiv-negative patients: experience from a tertiary referral center of south india |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924508/ https://www.ncbi.nlm.nih.gov/pubmed/20814494 http://dx.doi.org/10.4103/0972-2327.64635 |
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