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Primary Central Nervous System Infection by Histoplasma in an Immunocompetent Adult

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Abstract

Central nervous system (CNS) infection by Histoplasma capsulatum is a rare disease in immunocompromised individuals in endemic areas. About one quarter of cases result from hematogenous dissemination. A 23-year-old upholsterer with chronic occipital headache had developed intracranial hypertension and dizziness, incoordination with ataxic gait, and acute confusion 5 months prior to admission. Laboratory examinations and chest roentgenogram were normal. Postcontrast T1-weighted MRI of the brain revealed a multiple ring-enhancing cerebellar, brain stem and parietal lobe lesions, and meningeal contrast enhancement. Cerebrospinal fluid culture was positive for H. capsulatum species complex, which was confirmed by phylogenetic analysis. Thirteen years after the diagnosis and treatment, there was no H. capsulatum recurrence; sequels related to complications due to the ventriculoperitoneal shunt. This case shows a primary neurological presentation of cerebral histoplasmosis, without meningitis or disseminated disease in nonimmune-compromised patient. The authors propose a categorization of the diagnosis of CNS histoplasmosis. Routine diagnostics of sibling species within the H. capsulatum complex proved to be difficult.

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Acknowledgements

We thank the team of the service ambulatory and the team from Molecular Microbiology Laboratory—LabMicro/UFPR for their cooperation and assistance. The work of R.R. Gomes, K. Zamarchi, G.X. Schneider, and E.C.M. Imano was supported by a fellowship from the Brazilian Federal Agency for Support and Evaluation of Graduate: Education Coordination for the Improvement in Higher Education Personnel—CAPES (www.capes.gov.br), and V.A. Vicente received a fellowship from National Council of Technological and Scientific Development (http://cnpq.br/) (Grant Number 312811/2018-7), Brasilia, Brazil and thanks CAPES-PRINT (www.prppg.ufpr.br/site/print/pb/) for short-term fellowship (Grant Number 88887.468196/2019-00), Brasilia, Brazil.

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Authors and Affiliations

  1. Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil

    Elaine C. M. Imano, Vania A. Vicente, Renata R. Gomes, Kassiely Zamarchi & Gabriela X. Schneider

  2. Diagnostic Support Unit, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil

    Sérgio M. de Almeida & Ana P. Trentin

  3. Neuroinfection Clinic, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil

    Ana P. Trentin

  4. Department of Mycology, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil

    Rosangela L. Pinheiro

  5. Bioprocess Engineering and Biotechnology Department, Federal University of Parana, Curitiba, Parana, Brazil

    Nickolas M. da Silva

  6. Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands

    G. S. de Hoog

  7. Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    G. S. de Hoog

Authors
  1. Sérgio M. de Almeida
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  2. Elaine C. M. Imano
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  3. Vania A. Vicente
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  4. Renata R. Gomes
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  10. G. S. de Hoog
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Correspondence to Vania A. Vicente.

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de Almeida, S.M., Imano, E.C.M., Vicente, V.A. et al. Primary Central Nervous System Infection by Histoplasma in an Immunocompetent Adult. Mycopathologia 185, 331–338 (2020). https://doi.org/10.1007/s11046-019-00394-z

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