Central nervous system histoplasmosis

Joseph Wheat, Thein Myint, Ying Guo, Phebe Kemmer, Chadi Hage, Colin Terry, Marwan M. Azar, James Riddell, Peter Ender, Sharon Chen, Kareem Shehab, Kerry Cleveland, Eden Esguerra, James Johnson, Patty Wright, Vanja Douglas, Pascalis Vergidis, Winnie Ooi, John Baddley, David BambergerRaed Khairy, Holenarasipur Vikram, Elizabeth Jenny-Avital, Geetha Sivasubramanian, Karen Bowlware, Barbara Pahud, Juan Sarria, Townson Tsai, Maha Assi, Satish Mocherla, Vidhya Prakash, David Allen, Catherine Passaretti, Shirish Huprikar, Albert Anderson

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment. A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment. Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment. While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

Original languageEnglish (US)
Article numbere0245
JournalMedicine (United States)
Volume97
Issue number13
DOIs
StatePublished - Mar 1 2018

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Keywords

  • antibody
  • antigen
  • brain
  • diagnosis
  • histoplasma
  • histoplasmosis
  • meningitis
  • outcome
  • treatment

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wheat, J., Myint, T., Guo, Y., Kemmer, P., Hage, C., Terry, C., Azar, M. M., Riddell, J., Ender, P., Chen, S., Shehab, K., Cleveland, K., Esguerra, E., Johnson, J., Wright, P., Douglas, V., Vergidis, P., Ooi, W., Baddley, J., ... Anderson, A. (2018). Central nervous system histoplasmosis. Medicine (United States), 97(13), [e0245]. https://doi.org/10.1097/MD.0000000000010245