Journal Article

Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era

J. Ryan Bariola, Paul Perry, Peter G. Pappas, Laurie Proia, Wesley Shealey, Patty W. Wright, James M. Sizemore, Matthew Robinson and Robert W. Bradsher

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 6, pages 797-804
Published in print March 2010 | ISSN: 1058-4838
Published online March 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/650579
Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era

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Background. Central nervous system (CNS) involvement with Blastomyces dermatitidis is an uncommon and potentially fatal complication of blastomycosis.

Methods. We retrospectively reviewed 22 patients with CNS blastomycosis at our institutions from 1990 through 2008 (13 proven, 5 probable, and 4 possible cases).

Results. Magnetic resonance imaging was used in most patients, alone or in addition to computed tomography. CNS blastomycosis manifested as epidural abscess (1 of 22), meningitis (7 of 22), intracranial mass lesions (10 of 22), and concomitant intracranial mass lesions and meningitis (4 of 22). All patients received amphotericin B deoxycholate or a lipid formulation of amphotericin B as part of their treatment regimens. Most patients received amphotericin B followed by a prolonged course of oral azole therapy (voriconazole, fluconazole, or itraconazole). Four (18%) of 22 patients died during follow-up.

Conclusions. On the basis of these data, we recommend initial treatment with a lipid formulation of amphotericin B followed by a prolonged course of oral azole therapy, preferably voriconazole.

Journal Article.  3900 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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