RESUMEN
OBJECTIVE: To report our observations regarding fungal infections of the brain over two years from a large tertiary hospital in northern India. To identify fungal infections in immunocompetent and immunocompromised patients and to compare the two groups with respect to their age of occurrence, demographic data, clinical profile, radiological findings, response to treatment and outcome. METHODS: All consecutive cases of central nervous system (CNS) fungal infections admitted to the hospital over two years were included in this study. The patients were categorized as immunocompetent and immunocompromised, the predisposing factors, symptoms and clinical presentation were studied in detail and the outcomes of the two groups were compared. RESULTS: Of the 50 cases, 25(50%) were that of mucormycosis, 17(34%) were cryptococcosis and 8(16%) cases were that of aspergillosis. 14(28%) cases were immunocompetent and 36(72%) were immunocompromised. The outcome studied was as follows: 28% died of which 4% were HIV positive, 12% were diabetics with severe rhinorbital involvement, 2% had idiopathic thrombocytopenic purpura (ITP), 6% had advanced cancer and 4% had no predisposing illness. CONCLUSIONS: We observed fungal infections of the brain in both immunocompetent and immunocompromised patients. In immunocompetent patients, early diagnosis and appropriate treatment frequently leads to recovery from the illness. The mortality and morbidity of fungal infections are less in the immunocompetent group of patients.
Asunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Aspergilosis/complicaciones , Aspergilosis/epidemiología , Encéfalo/microbiología , Encéfalo/patología , Causalidad , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Criptococosis/complicaciones , Criptococosis/epidemiología , Femenino , Humanos , Inmunocompetencia , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , India/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The lungs and brain are commonly involved. Typical, but nonspecific, findings are often seen on imaging and the presence of concomitant lesions in these two systems often suggests this diagnosis. We report two cases of cerebral and pulmonary involvement by nocardiosis.