Rubén Valdivia

Parasitosis and mycosis of the central nervous system: 20 years of experience

Sir: Our 20-year experience with 10 cases of parasitosis and mycosis of the central nervous system (paracoccidioidomycosis, toxoplasmosis, histoplasmosis, amebiasis, candidiasis, cysticercosis) at the Childrens Hospital J. M. De Los Rios, in Caracas has prompted us to write this letter. Our cases were all verified histopathologically. In Latin American, Chagas disease occurs in Venezuela but there is no Echinococcus, which is indeed present in the southern part of the continent. Most of our cases were diagnosed before the era of tomography. They ranged in age from 2 months to 10 years; 4 were female and 7 male. The presenting symptoms and signs varied with the etiology, such as intracranial hypertension in cases of paracoccidioidomycosis or cysticercosis [10]; a case of toxoplasmosis presented with paraplegia and a thoracic sensory level [9]. The cases wi th amebiasis and candidiasis did not show any common neurological characteristics. The cerebral abscesses were diagnosed postmortem (abdominal infection and burn sepsis) [2]. The length of history varied from 1 day to 1 year. All CSF examined was pathologic in all components, with the exception of the case of amebiasis which showed only moderate pleocytosis (7 cells, 30% polynuclears) and normal chemical results. From the neurosurgical point of view, 7 of the 11 cases were operated upon: two posterior fossa and one left parietal craniotomies, 3 ventriculoperitoneal shunts, 1 dorsal laminectomy. The evolution was fatal in 3 of the cases (between 24 h and 219 days after discharge); the remaining cases were uneventful. Zooparasitosis, phytoparasitosis, and mycosis [5], thanks to current diagnostic methodology, are now treatable and in some cases curable. Their epidemiology is a result of interactions between host and parasite. Some of these parasites are characterized by neurotropism (cysticerci, toxoplasmosis, Cryptococcus), whereas others (Echinococcus) are not and some reach the CNS erratically (amebiasis, bilharziasis, paragonomiasis) [6]. Neurotropism of many parasites is determined by the