625. Central Nervous System Blastomycosis in North Central Wisconsin
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Central nervous system (CNS) involvement with Blastomyces dermatitidis(Bd) is an uncommon and potentially fatal complication of blastomycosis, which is difficult to diagnose and treat.

Methods:

We used the Marshfield Epidemiologic Study Area (MESA) database to identify 10 patients with CNS blastomycosis diagnosed over the last 30 years in north central Wisconsin, an endemic area for blastomycosis.

Results:

8/10 (80%) patients were male; median age 50 years (range 26-89 years). 4/10 (40%) had immune dysfunction (3 diabetes mellitus (DM), 1 on steroids). Neurologic symptoms included headache (5), altered mental status (2), seizure (2), neck pain (2), focal deficit (1) and visual disturbance (1). 9/10 (90%) had involvement of other organ systems (8 pulmonary, 3 bone and 1 skin). All patients had abnormal CNS imaging (6 abscess, 3 epidural mass and 1 with intracranial mass lesion and meningitis. All 6 patients with abscess had solitary lesion. Sites of abscess were brainstem (2), frontal (2), temporal (1) and parietal lobe (1). Cerebrospinal fluid (CSF) culture was positive for Bd in 1 patient. 4 patients had positive Bd culture from CNS biopsy. Magnetic resonance imaging was used in most patients, either alone or in addition to computed tomography. 9/10 (90%) first received amphotericin B (AmB) followed by an azole (5 Fluconazole, 2 itraconazole and 2 voriconazole). 1 patient was treated with Fluconazole only. None of the patients died due to CNS blastomycosis.

Conclusion:

CNS blastomycosis remains rare and is often associated with other sites of infection.  The most common neurological symptom is headache. DM may be associated with CNS blastomycosis. Evaluation of spinal fluid is rarely definitive for the organism.  Initial treatment is usually with AmB followed by a prolonged course of oral azole.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Subhashis Mitra, MD , Internal Medicine, Marshfield Clinic, Marshfield, WI
Papia Kar, MD , Internal Medicine, Marshfield Clinic, Marshfield, WI
Matthew C. Hall, MD , Marshfield Clinic, Marshfield, WI

Disclosures:

S. Mitra, None

P. Kar, None

M. C. Hall, None

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