Chronic meningoencephalitis due to Histoplasma capsulatum. Usefulness of serodiagnostic procedures in diagnosis

This study presents details of four male patients with meningoencephalitis of chronic evolution, probably due to Histoplasma capsulatum. The diagnoses were mainly made by immunodiffusion test (ID), counterimmunoelectrophoresis test (CIF) and complement fixation test (CFT) with specific antigens. In case 1, the diagnosis of histoplasmosis was established through the isolation of H. capsulatum from a cutaneous biopsy and in the other three patients, through the results of serological tests. The neurological changes were those typical of chronic meningitis of basal predominance, with non-purulent cerebrospinal fluid (CSF) and signs of hydrocephaly in three patients. Two patients had other organ involvement which was clinically consistent with histoplasmosis (nose, oral mucosa, lungs, adrenal glands). The four patients were treated with amphotericin B and received fluconazole, itraconazole, cotrimoxazole (TMS) and ketoconazole, in most cases as secondary prophylaxis. Three of the patients presented episodes of valvular obstruction which complicated their clinical courses.