Table 4.

Salient Points Regarding Central Nervous System (CNS) Sporotrichosis.

Clinical Aspects

Two major manifestations ➢Isolated chronic meningitis in immunocompetent patients who have symptoms (headache, ataxia, confusion, etc.) for weeks to months ➢Acute meningitis (headache, mental status changes, seizures) seen almost entirely in patients with HIV/AIDS with CD4 cells <100 μL as one manifestation of disseminated sporotrichosis. Most patients have many cutaneous lesions

Diagnosis

➢Definite CNS sporotrichosis: positive culture from cerebrospinal fluid (CSF) (uncommon in chronic meningitis) ➢Presumptive CNS sporotrichosis: positive culture from another involved site (generally skin lesion) OR positive histopathology from another involved site in a patient with disseminated sporotrichosis and symptoms and signs of meningitis ➢Serology on CSF may be useful for chronic meningitis; not standardized; available in reference laboratories

Treatment and Outcomes

➢Amphotericin B, preferably lipid formulation, 5 mg/kg daily for 4–6 weeks ➢Step-down therapy with itraconazole, 200 mg twice daily for at least 12 months ➢Posaconazole, 300 mg daily, might be efficacious if itraconazole is not tolerated ➢Life-long maintenance azole therapy often required ➢Antiretroviral therapy for patients with HIV infection ➢Outcomes are poor for patients with HIV infection and disseminated sporotrichosis; have improved with azole therapy for patients with chronic meningitis