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Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.

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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29595679
OWN - NLM
STAT- MEDLINE
DCOM- 20180411
LR  - 20180420
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - Central nervous system histoplasmosis: Multicenter retrospective study on
      clinical features, diagnostic approach and outcome of treatment.
PG  - e0245
LID - 10.1097/MD.0000000000010245 [doi]
AB  - 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.
FAU - Wheat, Joseph
AU  - Wheat J
FAU - Myint, Thein
AU  - Myint T
AD  - University of Kentucky School of Medicine, Lexington, Kentucky.
FAU - Guo, Ying
AU  - Guo Y
AD  - Emory University Rollins School of Public Health.
FAU - Kemmer, Phebe
AU  - Kemmer P
AD  - Emory University Rollins School of Public Health.
FAU - Hage, Chadi
AU  - Hage C
AD  - Indiana University School of Medicine.
FAU - Terry, Colin
AU  - Terry C
AD  - Indiana University Health, Indianapolis, Indiana.
FAU - Azar, Marwan M
AU  - Azar MM
AD  - Yale University School of Medicine, New Haven, Connecticut.
FAU - Riddell, James
AU  - Riddell J
AD  - University of Michigan Health System, Ann Arbor, Michigan.
FAU - Ender, Peter
AU  - Ender P
AD  - St. Luke's University Hospital and Health Network, Bethlehem.
FAU - Chen, Sharon
AU  - Chen S
AD  - Stanford University School of Medicine, Stanford.
FAU - Shehab, Kareem
AU  - Shehab K
AD  - University of Arizona College of Medicine, Tucson.
FAU - Cleveland, Kerry
AU  - Cleveland K
AD  - University of Tennessee Health Sciences Center, Memphis.
FAU - Esguerra, Eden
AU  - Esguerra E
AD  - Mercy Hospital, Joplin.
FAU - Johnson, James
AU  - Johnson J
AD  - Vanderbilt University School of Medicine, Nashville, Tennessee.
FAU - Wright, Patty
AU  - Wright P
AD  - University of California at San Francisco School of Medicine, San Francisco.
FAU - Douglas, Vanja
AU  - Douglas V
AD  - University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
FAU - Vergidis, Pascalis
AU  - Vergidis P
AD  - Lahey Hospital and Medical Center, Burlington, Massachusetts.
FAU - Ooi, Winnie
AU  - Ooi W
AD  - Lahey Hospital and Medical Center, Burlington, Massachusetts.
FAU - Baddley, John
AU  - Baddley J
AD  - University of Alabama- Birmingham, Birmingham, Alabama.
FAU - Bamberger, David
AU  - Bamberger D
AD  - University of Missouri-Kansas City, Kansas City.
FAU - Khairy, Raed
AU  - Khairy R
AD  - Sparks Center for Infectious Diseases, Fort Smith, Arkansas.
FAU - Vikram, Holenarasipur R
AU  - Vikram HR
AD  - Mayo Clinic, Phoenix, Arizona.
FAU - Jenny-Avital, Elizabeth
AU  - Jenny-Avital E
AD  - Jacobi Medical Center, Bronx.
FAU - Sivasubramanian, Geetha
AU  - Sivasubramanian G
AD  - Metro Infectious Diseases, Chicago.
FAU - Bowlware, Karen
AU  - Bowlware K
AD  - University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
FAU - Pahud, Barbara
AU  - Pahud B
AD  - Children's Mercy Hospital, Kansas City, Missouri.
FAU - Sarria, Juan
AU  - Sarria J
AD  - University of Texas Medical Branch, Galveston.
FAU - Tsai, Townson
AU  - Tsai T
AD  - Kaiser Permanente, Los Angeles, California.
FAU - Assi, Maha
AU  - Assi M
AD  - Infectious Disease Consultants, Wichita, Kansas.
FAU - Mocherla, Satish
AU  - Mocherla S
AD  - Premier Physicians, Midland, Texas.
FAU - Prakash, Vidhya
AU  - Prakash V
AD  - Southern Illinois University School of Medicine, Springfield, Illinois.
FAU - Allen, David
AU  - Allen D
AD  - Courage Fund, National University of Singapore, Singapore.
FAU - Passaretti, Catherine
AU  - Passaretti C
AD  - Carolinas Medical Center, Charlotte, North Carolina.
FAU - Huprikar, Shirish
AU  - Huprikar S
AD  - Icahn School of Medicine at Mount Sinai, New York, New York.
FAU - Anderson, Albert
AU  - Anderson A
AD  - Emory University School of Medicine, Atlanta, Georgia.
LA  - eng
GR  - K23 MH095679/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antibodies, Fungal)
RN  - 0 (Antigens, Fungal)
RN  - 0 (liposomal amphotericin B)
RN  - 7XU7A7DROE (Amphotericin B)
SB  - AIM
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/complications
MH  - Age Factors
MH  - Amphotericin B/*therapeutic use
MH  - Antibodies, Fungal/cerebrospinal fluid
MH  - Antigens, Fungal/cerebrospinal fluid
MH  - Brain/diagnostic imaging
MH  - Central Nervous System Fungal Infections/complications/*diagnosis/*drug
      therapy/mortality
MH  - Female
MH  - Histoplasmosis/complications/*diagnosis/*drug therapy/mortality
MH  - Humans
MH  - Immunocompromised Host
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Spinal Cord/drug effects
PMC - PMC5895412
EDAT- 2018/03/30 06:00
MHDA- 2018/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/12 06:00 [medline]
AID - 10.1097/MD.0000000000010245 [doi]
AID - 00005792-201803300-00052 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e0245. doi: 10.1097/MD.0000000000010245.