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.
"In immunocompromised patients and rapidly progressive lesions the fungi proliferate in great numbers forming " yeast lakes " with only minimal inflammatory response. Amphotericin B, alone or sometimes in combination with other antifungal agents (Panicker et al., 2006; Borgia et al., 2006), is the drug of choice for severe life-threatening disease. Voriconazole was reported to be successful in treatment of cerebral blastomycosis as well (Bakleh et al., 2005; Borgia et al., 2006). "
[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: To describe the clinical and histopathologic findings of a unique case of isolated optic nerve Blastomyces dermatitidis infection and to summarize the ophthalmic blastomycosis literature.
Case report and systematic literature review.
A 70-year-old healthy man experienced impaired vision in his left eye. Magnetic resonance imaging (MRI) showed an enhancing process of the left optic nerve sheath. Although vision initially improved with oral dexamethasone, visual acuity subsequently decreased from 20/25 to no light perception over 8 weeks. An optic nerve biopsy revealed blastomycosis. Because ophthalmic blastomycosis infections are unusual, the Cochrane Library, PubMed, OVID, and UpToDate databases were searched using the term blastomycosis with the limits English and humans. Articles that predated the databases were gathered from current references.
Visual acuity of the left eye and MRI of the orbits and brain.
Histopathologic examination of the nerve specimen showed B. dermatitidis infection. Needle biopsy and culture results of a suspicious lung scar were positive for Blastomyces. The patient was treated with intravenous amphotericin B followed by oral itraconazole for 6 months. The left eye remained blind 23 months after the biopsy. Approximately 40 articles describing ophthalmic infection were found in the literature search.
Ophthalmic blastomycosis infections can cause rapid, complete vision loss. Prompt treatment is required, but infections are uncommon and usually are misdiagnosed, often because of lack of biopsy results. Tissue must be biopsied, cultured, or both for a definitive diagnosis. Because virtually all blastomycosis cases begin in the lungs, a chest radiograph or computed tomographic scan should be obtained. Any questionable lung lesion should be biopsied to corroborate possible ophthalmic disease.
[Show abstract][Hide abstract] ABSTRACT: Evidence-based guidelines for the management of patients with blastomycosis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous management guidelines published in the April 2000 issue of Clinical Infectious Diseases. The guidelines are intended for use by health care providers who care for patients who have blastomycosis. Since 2000, several new antifungal agents have become available, and blastomycosis has been noted more frequently among immunosuppressed patients. New information, based on publications between 2000 and 2006, is incorporated in this guideline document, and recommendations for treating children with blastomycosis have been noted.
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