Abstract

Blastomycosis is a local or systemic infection, caused by Blastomyces dermatitidis (B. dermatitidis) or B. gilchristii. Blastomycosis has been described as “the great pretender,” alluding to the fact that it manifests in a wide range of symptoms and disease severity. Central nervous system (CNS) involvement, although rare, carries significant mortality. Due to the limited published reports of CNS blastomycosis, we present an updated cohort with eight cases of proven or probable CNS blastomycosis describing presentation, diagnosis, treatment and outcomes. Headache was the most common presenting symptom. Magnetic resonance imaging (MRI) proved to be the superior imaging study. All patients in our cohort were diagnosed by histopathological staining or cultures of tissue or fluid obtained from CNS or extra-CNS lesions. All patients that received treatment with Liposomal amphrotericin B for at least 10 days followed by a prolonged azole therapy did not have relapse. Two patients with late diagnoses died during hospitalization. Our findings confirm the importance of timely diagnosis and treatment of CNS blastomycosis to improve outcomes especially with an azole that have a high CNS penetration and a good intrinsic activity for B. dermatitidis such as voriconazole.

中文翻译：

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中枢神经系统芽孢杆菌病的临床特征和结局。

摘要

芽孢杆菌病是由皮肤芽孢杆菌（B. dermatitidis）或吉尔氏芽孢杆菌（B. gilchristii ）引起的局部或全身感染。芽孢杆菌病被描述为“伟大的伪装者”，暗示了它在多种症状和疾病严重程度中表现出来。中枢神经系统（CNS）的参与虽然很少见，但死亡率很高。由于中枢神经母细胞芽孢菌病的出版报道有限，我们提供了一个更新的队列，其中包括8例经证实或可能的中枢神经母细胞芽孢菌病，描述了表现，诊断，治疗和结局。头痛是最常见的症状。磁共振成像（MRI）被证明是卓越的成像研究。我们队列中的所有患者均通过组织病理学染色或培养自中枢神经系统或中枢神经系统外病变的组织或体液进行诊断。所有接受脂质体两性霉素B治疗至少10天，然后接受长期唑治疗的患者均未复发。两名诊断较晚的患者在住院期间死亡。我们的研究结果证实了及时诊断和治疗中枢神经系统芽孢杆菌病对改善预后的重要性，尤其是对于具有高中枢神经系统渗透率和良好内在活性的唑类药物而言。皮肤炎双歧杆菌，例如伏立康唑。