Abstract：
BACKGROUND: Advanced neuroimaging demonstrated that neurological involvement occurs in up to 30% of paracoccidioidomycosis (PCM) cases. Current knowledge of neuroparacoccidioidomycosis (NPCM) is based on a 2009 systematic review. However, in the last decade, several new cases have been published, with modern neuroimaging techniques.
OBJECTIVE: We believe a new systematic review is needed to summarise these advances.
METHODS: We searched PubMed/MEDLINE, Embase and LILACS for studies from January 2010 to May 2022. Case series and case reports of NPCM were included. We performed a metaproportion to estimate a summary proportion with 95% confidence intervals (CI).
RESULTS: Thirty-four studies including 104 patients were evaluated. We combined our data with the results from the previous review that included 257 cases, totalling 361 patients. We found no new important demographic, clinical or laboratory characteristics. On magnetic resonance imaging (MRI), we found that 72% (95%CI: 38-91) had hyperintensity on T1-weighted image; 84% (95%CI: 71%-92%) had hypointensity on T2-weighted image; 80% (95%CI: 66-89) had contrast enhancement with the classical ring-enhancing pattern. All 8 patients undergoing spectroscopy presented lipid peaks. We found a 16% mortality, lower than in the previous review (44%).
CONCLUSIONS: NPCM presents a characteristic pattern on MRI that may help to differentiate it from other causes of single or multiple brain lesions. Albeit there is a frequent pattern, it is not specific, as other granulomatous diseases may show similar findings. Advances in neuroimaging with early diagnosis and appropriate management of the disease may have contributed to reducing its mortality.
OBJECTIVE: We believe a new systematic review is needed to summarise these advances.
METHODS: We searched PubMed/MEDLINE, Embase and LILACS for studies from January 2010 to May 2022. Case series and case reports of NPCM were included. We performed a metaproportion to estimate a summary proportion with 95% confidence intervals (CI).
RESULTS: Thirty-four studies including 104 patients were evaluated. We combined our data with the results from the previous review that included 257 cases, totalling 361 patients. We found no new important demographic, clinical or laboratory characteristics. On magnetic resonance imaging (MRI), we found that 72% (95%CI: 38-91) had hyperintensity on T1-weighted image; 84% (95%CI: 71%-92%) had hypointensity on T2-weighted image; 80% (95%CI: 66-89) had contrast enhancement with the classical ring-enhancing pattern. All 8 patients undergoing spectroscopy presented lipid peaks. We found a 16% mortality, lower than in the previous review (44%).
CONCLUSIONS: NPCM presents a characteristic pattern on MRI that may help to differentiate it from other causes of single or multiple brain lesions. Albeit there is a frequent pattern, it is not specific, as other granulomatous diseases may show similar findings. Advances in neuroimaging with early diagnosis and appropriate management of the disease may have contributed to reducing its mortality.
摘要：
背景：先进的神经影像学显示，神经系统受累发生在高达30％的副宫颈真菌病（PCM）病例中。神经副角菌病（NPCM）的当前知识基于2009年的系统评价。然而,在过去的十年里，已经发布了几个新案例，现代神经成像技术。
目的：我们认为需要一个新的系统评价来总结这些进展。
方法：我们搜索了PubMed/MEDLINE，Embase和LILACS用于2010年1月至2022年5月的研究。包括NPCM的病例系列和病例报告。我们用95%置信区间(CI)进行了超比例估计汇总比例。
结果：评估了34项研究，包括104例患者。我们将我们的数据与之前的包括257例病例的审查结果相结合，共有361名患者。我们没有发现新的重要人口，临床或实验室特征。在磁共振成像(MRI)上，我们发现,72%(95CI:38~91)在T1加权图像上有高强度;84%(95CI:71%~92%)在T2加权图像上有低强度;80%(95CI:66~89)与经典环增强模式相比有对比度增强.接受光谱学的所有8名患者均呈现脂质峰。我们发现16%的死亡率,低于上次审查(44%)。
结论：NPCM在MRI上表现出特征性模式，可能有助于将其与单发或多发脑部病变的其他原因区分开来。尽管有一种常见的模式，它不是具体的，其他肉芽肿疾病可能也有类似的发现。神经影像学的早期诊断和疾病的适当管理可能有助于降低其死亡率。
目的：我们认为需要一个新的系统评价来总结这些进展。
方法：我们搜索了PubMed/MEDLINE，Embase和LILACS用于2010年1月至2022年5月的研究。包括NPCM的病例系列和病例报告。我们用95%置信区间(CI)进行了超比例估计汇总比例。
结果：评估了34项研究，包括104例患者。我们将我们的数据与之前的包括257例病例的审查结果相结合，共有361名患者。我们没有发现新的重要人口，临床或实验室特征。在磁共振成像(MRI)上，我们发现,72%(95CI:38~91)在T1加权图像上有高强度;84%(95CI:71%~92%)在T2加权图像上有低强度;80%(95CI:66~89)与经典环增强模式相比有对比度增强.接受光谱学的所有8名患者均呈现脂质峰。我们发现16%的死亡率,低于上次审查(44%)。
结论：NPCM在MRI上表现出特征性模式，可能有助于将其与单发或多发脑部病变的其他原因区分开来。尽管有一种常见的模式，它不是具体的，其他肉芽肿疾病可能也有类似的发现。神经影像学的早期诊断和疾病的适当管理可能有助于降低其死亡率。
