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Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors
  1. P A Kowacs1,
  2. C E Soares Silvado1,
  3. S Monteiro de Almeida1,
  4. M Ramos2,
  5. K Abrão1,
  6. L E Madaloso3,
  7. R L Pinheiro4,
  8. L C Werneck1
  1. 1Division of Neurology, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, 80060–900 Curitiba, Brazil
  2. 2Division of Infectious Diseases, Hospital XV, 80050-000 Curitiba, Brazil
  3. 3Division of Neurosurgery, Hospital de Clínicas da Universidade Federal do Paraná
  4. 4Mycology Laboratories, Hospital de Clínicas da Universidade Federal do Paraná
  1. 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;


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.

  • Near drowning
  • Pseudallescheria boydii
  • Scedosporium apiospermum
  • brain abscess
  • meningitis
  • CNS, central nervous system
  • CSF, cerebrospinal fluid
  • CT, computerised tomography

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