THUR 134 Isolated CNS histoplasmosis in an immunocompetent patient
Bibliographic record
Abstract
A 26-year-old Bolivian man presented with a 3 year history of occipital headaches and bilateral papilloedema. MRI showed communicating hydrocephalus and leptomeningeal enhancement. CSF analysis revealed an opening pressure of 32cmH2O, lymphocytic pleocytosis, protein 1.9 g/dL and CSF glucose 0.4 mmol/L. CSF AFB, bacterial and fungal culture, TB-PCR, 18S rDNA PCR, serum b-d glucan, and HIV were all negative. Serum ACE was normal. Steroids and methotrexate were commenced for probable neurosarcoidosis. He had readmissions with recurrent headache, meningism, symptoms of raised intracranial pressure and development of limb spasticity and brisk reflexes. Repeat imaging demonstrated stable hydrocephalus. Despite immunosuppression and empirical TB treatment, he remained symptomatic with a persistently active CSF: maximum opening pressure 36cmH2O, protein 3.9 g/dL, WCC 205 lymphocytes and low CSF-to-serum glucose ratio on repeated therapeutic LPs. After re-evaluation and positive CSF b-d glucan, a diagnosis of Histoplasma meningitis, without systemic dissemination, was confirmed by positive serological and CSF tests: positive immunodiffusion; yeast CFT 1:16; CSF EIA antigen 0.85 ng/ml. He was treated with AmBisome, followed by oral itraconazole, with complete symptom resolution and improvement on interval imaging. We discuss challenges in reaching a diagnosis of isolated histoplasmosis, its neurological manifestations and diagnostic pathway in evaluating patients with suspected CNS fungal infection.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".