Histoplasma Meningitis

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Abstract
Histoplasma capsulatum was isolated in culture from the cerebrospinal fluid of 4 patients and from the sputum of the fifth. All patients had lymphocytic meningitis with elevated protein (100-655 mg/100 ml), 4 had elevated spinal fluid pressure, but only 2 had depressed glucose values. Chronicity was a striking clinical manifestation with duration of illness prior to diagnosis varying from 2 months to 7 years. The spectrum of neurologic illness varied from headache to confusion, localizing signs and coma. A stiff neck was present in only 2. A ventriculogram (1 patient), pneumoencephalogram (2 patients), cerebral arteriogram (2 patients), and a radioactive brain scan (3 patients) were performed in addition to lumbar puncture, skull films, and electroencephalograms. Chest films were negative in 3 patients, 1 patient had a soft peribronchial infiltration bilaterally, and the remaining patient had cavitary left upper lobe disease. The complement fixation tests were positive in 3 patients (highest titers, 1:8, 1:16, and 1:128) and persistently negative in 1 patient. Spinal fluid complement fixation was positive in 1:8 dilutions in 1 patient. Histoplasmin skin tests were negative in the 2 patients with positive blood and bone marrow cultures. Definitive therapy was considered in all cases to be amphotericin B, although courses of betadiethyl-aminofencholate (MRD-112), ethyl vacillate, nioetin, sulfadiazine and X-5079C were administered at various times. Three patients appear to have recovered from their infection; one died following mental deterioration and cachexia 20 months after treatment; and the remaining patient is asymptomatic, working daily, but has persistently abnormal cerebrospinal fluid findings with positive culture.

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