CASE REPORT

Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors

P A Kowacs¹, C E Soares Silvado¹, S Monteiro de Almeida¹, M Ramos², K Abrão¹, L E Madaloso³, R L Pinheiro⁴ and L C Werneck¹

¹ Division of Neurology, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, 80060–900 Curitiba, Brazil
² Division of Infectious Diseases, Hospital XV, 80050-000 Curitiba, Brazil
³ Division of Neurosurgery, Hospital de Clínicas da Universidade Federal do Paraná
⁴ Mycology Laboratories, Hospital de Clínicas da Universidade Federal do Paraná

Correspondence to:
Correspondence to:
Dr P A Kowacs
Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, 12 Andar, Sala 1236, 80060–900, Curitiba, Brazil; cefaleia{at}hc.ufpr.br

This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.

Keywords: Near drowning; Pseudallescheria boydii; Scedosporium apiospermum; brain abscess; meningitis

Abbreviations: CNS, central nervous system; CSF, cerebrospinal fluid; CT, computerised tomography

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Thornton, C. R. (2009). Tracking the Emerging Human Pathogen Pseudallescheria boydii by Using Highly Specific Monoclonal Antibodies. CVI 16: 756-764 [Abstract] [Full Text]  
• Cortez, K. J., Roilides, E., Quiroz-Telles, F., Meletiadis, J., Antachopoulos, C., Knudsen, T., Buchanan, W., Milanovich, J., Sutton, D. A., Fothergill, A., Rinaldi, M. G., Shea, Y. R., Zaoutis, T., Kottilil, S., Walsh, T. J. (2008). Infections Caused by Scedosporium spp.. Clin. Microbiol. Rev. 21: 157-197 [Abstract] [Full Text]  
• Capilla, J., Mayayo, E., Serena, C., Pastor, F. J., Guarro, J. (2004). A novel murine model of cerebral scedosporiosis: lack of efficacy of amphotericin B. J Antimicrob Chemother 54: 1092-1095 [Abstract] [Full Text]