Recurrent central nervous system blastomycosis in an immunocompetent child treated successfully with sequential liposomal amphotericin B and voriconazole.
ABSTRACT Central nervous system involvement in infection with Blastomyces dermatitidis is uncommon, except in immunocompromised patients. We report a case of central nervous system blastomycosis occurring 18 months after treatment of pulmonary blastomycosis in an immunocompetent child. Our patient was successfully treated sequentially with liposomal amphotericin B followed by oral voriconazole without need for surgical resection.
- SourceAvailable from: Samir S Amr[Show abstract] [Hide abstract]
ABSTRACT: There are four main causes of infections of the central nervous system (CNS). These include bacterial, viral, fungal, and protozoal agents. Bacterial infections can be caused by pyogenic organisms, or may be due to mycobacteria or spirochetes. Bacterial infections, particularly those due to pyogenic organisms, may lead to meningitis, brain abscess, epidural or subdural abscesses. Viral infections may also lead to meningitis, or can cause encephalitis, or myelitis. Protozoal infections that may affect the brain include toxoplasmosis, malaria, and amoebiasis.Progress in Mycology, 02/2011: chapter 5: pages 141-180;
- [Show abstract] [Hide abstract]
ABSTRACT: Blastomyces dermatitidis, a thermally dimorphic fungus endemic to areas of North America, causes a granulomatous infection which may affect any organ system. Since limited clinical data exist about pediatric blastomycosis, we conducted a retrospective review of medical records of pediatric patients with a laboratory-confirmed diagnosis of blastomycosis treated during a 30-year period at a tertiary care center. Thirty-four pediatric patients with blastomycosis were identified (20 [59%] male), with a mean age at diagnosis of 10 ± 5 years. Two patients were immunocompromised. Pulmonary disease was noted in 27 (79%) patients, and extrapulmonary disease was found in 13 (38%) patients (concurrent pulmonary and extrapulmonary disease, six patients), including five cases of central nervous system (CNS) disease. Delay in diagnosis was greater with extrapulmonary or central nervous system infections as compared with pulmonary blastomycosis. All patients received antifungal chemotherapy, with 19 (56%) patients receiving amphotericin B as initial therapy for 27.5 ± 17 days. Five patients required treatment in the intensive care unit. One patient died of non-Hodgkins lymphoma. Blastomycosis may occur in healthy children, including very young infants. Due to the frequency of extra-pulmonary disease, diagnosis may be difficult and frequently delayed, especially in cases of CNS infection.Medical mycology: official publication of the International Society for Human and Animal Mycology 02/2011; 49(6):627-32. DOI:10.3109/13693786.2010.547994 · 2.26 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The incidence of invasive mycoses is increasing, especially among patients who are immunocompromised or hospitalized with serious underlying diseases. Such infections may be broken into two broad categories: opportunistic and endemic. The most important agents of the opportunistic mycoses are Candida spp., Cryptococcus neoformans, Pneumocystis jirovecii, and Aspergillus spp. (although the list of potential pathogens is ever expanding); while the most commonly encountered endemic mycoses are due to Histoplasma capsulatum, Coccidioides immitis/posadasii, and Blastomyces dermatitidis. This review discusses the epidemiologic profiles of these invasive mycoses in North America, as well as risk factors for infection, and the pathogens' antifungal susceptibility.Critical Reviews in Microbiology 02/2010; 36(1):1-53. DOI:10.3109/10408410903241444 · 6.09 Impact Factor