Central Nervous System Histoplasmosis: An Updated Insight

Pathogens, 2023 · DOI: 10.3390/pathogens12050681 · Published: May 5, 2023

Simple Explanation

Histoplasmosis, a fungal infection, can affect the central nervous system (CNS), leading to severe conditions like meningitis or brain lesions. The review focuses on the epidemiology, how it manifests clinically, how it progresses in the body, how it is diagnosed, and what treatments are available, specifically concerning the CNS. The fungus, Histoplasma capsulatum, can cause life-threatening injuries in the CNS, presenting as meningitis, abscesses, or spinal cord injuries.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
CNS histoplasmosis, while less frequent than other forms, is associated with high mortality rates, even with aggressive treatments.
2
Diagnosis is challenging due to the low sensitivity of laboratory tests and the varied clinical manifestations of the disease.
3
The review recommends considering Histoplasma in patients with unexplained neurological symptoms, chronic meningitis, or parenchymatous lesions, especially when other causes have been ruled out.

Research Summary

Histoplasmosis can involve the Central Nervous System (CNS) and is caused by Histoplasma capsulatum complex species. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. CNS histoplasmosis is not a common clinical form of histoplasmosis, occurring only in 10% to 20% of disseminated histoplasmosis cases. However, it is associated with high mortality rates, even in the context of aggressive treatments. Given that CNS histoplasmosis has multiple clinical manifestations and no typical clinical picture, which is further combined by the diagnostic difﬁculties caused by the low sensitivity of laboratory tests, clinical suspicion of CNS histoplasmosis is low.

Practical Implications

Improved Diagnosis

Increased awareness and consideration of CNS histoplasmosis in differential diagnoses could lead to earlier and more accurate diagnoses.

Treatment Strategies

Aggressive and prolonged therapy, possibly involving liposomal amphotericin B and azoles, is crucial for managing CNS histoplasmosis.

Clinical Surveillance

Post-treatment clinical surveillance for at least a year helps prevent relapses in affected individuals.

Study Limitations

1
The scarcity and variability of clinical cases make it difficult to establish definitive treatments.
2
Low sensitivity of laboratory tests complicates the diagnosis of CNS histoplasmosis.
3
Many aspects regarding the natural history, environmental changes, and genetic structure of Histoplasma remain poorly understood.

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