BLASTOMYCOSIS OF CENTRAL NERVOUS SYSTEM .2. A REPORT OF 9 CASES FROM VETERANS ADMINISTRATION COOPERATIVE STUDY

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Abstract
In a series of 198 cases of proved blastomycosis, involvement of the central nervous system occurred in 9 patients (4.5%). Seven patients had definite or probable meningitis, whereas 8 had definite or probable involvement of the brain substance, usually in the form of abscesses, granulomas,or cerebritis. Nuchal rigidity was observed in only 2 patients. The cerebrospinal fluid protein and pressure were consistently elevated. Leukocyte counts in the fluid ranged from 6 to 350 per cu. mm., predominantly lymphocytes. The cerebrospinal fluid sugar was normal. Cultures of fluid were consistently negative for fungi, although abundant organisms were demonstrated microscopically in the brain and meninges at autopsy. The morality rate was 67%. Two patients recovered completely. One received 2-hydroxystilbamidine with multiple aspirations of a brain abscess; the 2nd was treated with 2-hydroxystilbamidine alone. Only 1 patient was treated with amphotericin B late in the course of his disease. Earlier diagnosis and more extensive use of amphotericin B gives promise of producing striking improvement in the prognosis of this disease. Cerebromenigeal blastomycosis is almost invariably associated with widespread disease of the skin, lung and other tissues. The diagnosis depends on the clinical picture, compatible cerebrospinal fluid abnormalities, and demonstration of Blastomyces dermatitidis in the sputum, skin, gastric contents, blood, urine, prostatic secretions, and drainage or aspirate from bone abscesses or biopsy materials.

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