Lara TCO, Aguirre QDE, Chávez ML, Olvera RJE

Language: Spanish
References: 12
Page: 196-201
PDF size: 415.75 Kb.

ABSTRACT

Background: The mycoses that affect the central nervous system (CNS) frequently complicate immunosupression states, such as patients with hematologic neoplasia, under chemo or radiotherapy, with organ transplants, acquired immunodeficiency syndrome (AIDS), diabetes mellitus or prosthetic cardiac valves. A great proportion of cases are not diagnosed during life and therefore, the incidence figures obtained from clinical charts are inaccurate.
Objectives: To determine, by autopsy protocols, the number of cases of fungal infections affecting central nervous system, as well as to describe the demography, etiological agents and changes on parameters if they have been on time.
Material and method: For this paper, the autopsy protocols of the Mexico City General Hospital were reviewed retrospectively, taking into special consideration the neuropathological study, in the period 1989-2004. Seventy-five cases (0.6%) of mycosis with involvement of the CNS were documented in a total of 11,737 autopsies.
Results: The clinical diagnosis of a fungus infection of the CNS was made in 11 cases (14.4%), 8 were mucormycosis. Other mycotic agents were Candida sp. Cryptococcus sp., Aspergillus sp. and Histoplasma capsulatum. The percentage of cases with respect to the number of autopsies in a given period was (1989-1993) 29 cases, (1994-1998) 28 cases, and (1999-2004) 18 cases.
Conclusions: The number of autopsies with mycotic infection of the CNS has decreased progressively due to improved measures of prevention and monitoring of patients with predisposing illnesses. However, a great number are not diagnosed during life.

REFERENCES

1. Graham D, Lantos P. Greenfield’s neuropathology. 7th ed. London: Arnold; 2002:132-141.

2. Hooper DC, Pruitt AA, Rubin RH. Central nervous system infection in the chronically immunosuppressed. Medicine (Baltimore) 1982;61:166-188.

3. Chimmelli L, Mahler-Araujo MB. Fungal infections. Brain Pathol 1997;7:613-627.

4. Tietz HJ, Martin H, Koch S. Incidence of endomycoses in autopsy material. Mycoses 2001;44:450-454.

5. Hoang LMN, Maguire JA, Doyle P, Fyfe M, Roscoe DL. Cryptococcus neoformans infections at Vancouver Hospital and Health Sciences Centre (1997-2002): epidemiology, microbiology and histopathology. J Med Microbiol 2004;53:935-940.

6. Reséndiz M, Velázquez G, Pérez J, Chávez L, Olvera J. Criptococosis cerebral. Análisis de 29 casos en 23 años de autopsias del Hospital General de México. Patología 2008;46:96-100.

7. Reyes PO, Velásquez GG, Lara TH, Chávez Macías L, Olvera Rabiela JE. Mucormicosis rinocerebral. Informe de quince casos de autopsia del Hospital General de México. Patología 2006;44:223-228.

8. Jensen HE, Salonen HM, Ekfors TO. The use of immunohistochemistry to improve sensitivity and specificity in the diagnosis of systemic mycoses in patients with haematological malignancies. J Pathol 1997;181:100-105.

9. Jensen HE, Schønheyder HC, Hotchi M, Kaufman L. Diagnosis of systemic mycoses by specific immunohistochemical test. APMIS 1996;104:241-258.

10. 10 Kaufman L. Immunohistologic diagnosis of systemic mycoses: an update. Eur J Epidemiol 1992;8:377-382.

11. Ho KL, Allevato PA, King P, Chason JL. Cerebral Paecilomyces javanicus infection. An ultrastructural study. Acta Neuropathol 1986;72(2):134-141.

12. Binford CH, Dooley JR. Diseases caused by fungi and actinomycetes. Deep mycoses. In: Binford CH, Connor DH, editors. Pathology of tropical and extraordinary diseases. Washington, DC: Armed Forces Institute of Pathology; 1976:551-609.