Table 2. Diagnosis of cases of CNS blastomycosis affecting the brain or spinal cord parenchyma.
# Tissue obtained
Tissue type
Histo-pathology result
Fungal culture result
Antibody testing
Antigen testing
CSF profile Other Reference
Chronic meningitis only
1 Yes Hip,
Brain, Dura
Normal tissues, no fungal stains performed
CSF: - Blood: - Bone marrow: -
Serum: + CSF: +
CSF: + Blood: + Urine: +
WBC: 185/mcL -60% lymph -10% mono P: 656 mg/dl G: <20 mg/dl
This report
Brain parenchymal disease
2 Yes Skin GMS stain: - Budding yeast on repeat biopsy
Sputum: - Urine: - Skin: - Bone: -
Serum: - U U DNA
probe on BAL
Brick et al [16]
3 Yes Skin Granulomatous appearance with multinucleated giant cells, GMS stain: -
Skin: + CSF: - CSF: - Urine: +
Abnormal, NOS Ribosom al RNA nucleic acid hybridizat ion from skin biopsy
Brick et al [16]
4 Yes Brain +, NOS U U U U Fanella et al
[11]
5 Yes Brain +, NOS U U U U Fanella et al
[11]
6 Yes Brain +, NOS U U U U Fanella et al
[11]
7 No n/a n/a BAL: + U U No cells Panicker et
(previous) Blood: - Urine: - CSF: -
P: normal G: normal
al [22]
8 Yes Intra-
cranial mass
Silver methionine stain: +
Lesion: - Serum: - U U Roos et al
[24]
9 Yes Brain Granuloma, multinucleated giant cell, neutrophils
Brain: + U U U Bush et al
[17]
10 Yes Brain, dura, ventricu lar nodule
Granuloma, multinucleated giant cells, neutrophils, fungus seen
Brain: - Serum: + U WBC 129/mcL
-77% lymph -14% mono -9% neut P: 90 mg/dL G: 32 mg/dL
Bush et al [17]
11 Yes Brain Granuloma, multinucleated giant cells, fungus seen
Brain: - Serum: + U WBC 3/mcL
-86% lymph -11% mono -3% neut P: 24 mg/dL, G: 65 mg/dL
Bush et al [17]
12 Yes Ventric
ular nodule
Granulomatous ventriculitis
CSF: - Serum: + U WBC 129
x10(6)/L P: 70 mg/dL G: U
Abrams et al
[14]
13 Yes Intra- cranial mass
KOH stain: + Lesion: + Blood: - Urine: -
Serum: + U U Gershan et
al [19]
14 Yes Intra- cranial mass
+ U Serum: + U U Tang et al
[25]
15 Yes Intra- cranial
Electron
microscopy and
Urine: - U U U Bell et al
[15]
mass frozen sections:
+, NOS 16 Yes Skin,
thyroid
Thyroid: +, NOS Skin: + U U U Bariola et al
[13]
17 U U U U U U U BAL and
urine, NOS
Kochar et al [28]
Spinal cord parenchymal disease 18 Yes Spinal
cord lesion
Granuloma, multinucleated giant cells, neutrophils, fungus seen
Sputum: + Lesion: +
U U WBC 3 /mcL
-87% lymph -13% mono P: 37 mg/dL G: 56 mg/dL
Bush et al [17]
19 Yes Spinal cord lesion
GMS stain: + Lesion: + CSF: -
U U WBC 3x10(6)
-87 % lymph -13% mono P: 37 mg/dL G: 56 mg/dL
Parr et al [23]
