A Case of Rapidly Progressive Coccidioidal Meningitis in an Immunocompetent Patient

Fatima, Mariam; Patel, Reema S; Brunworth, Jamie R; Gupta, Krisha A; Roach, Wesley E; Webeler, Paige L; Mundelein, Cherie R; Mansour, M.

doi:10.7759/cureus.28643

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…1 The majority were previously healthy, with no known immune deficiencies, consistent with other case series. 6,8,10,11 Recent reports have documented specific gene mutations which alter interleukin 12, interferon-gamma, and other cellular immune responses, and are associated with an increased risk of disseminated coccidioidomycosis, but these were not tested for in our patients. [12][13][14] Altered balance between type 2 immune response and interferon gammamediated type 1 immune response has been shown to increase susceptibility to disseminated coccidioidomycosis.…”

Section: Discussionmentioning

confidence: 97%

Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series

Naeem

Laningham

Giglio

et al. 2022

Pediatric Infectious Disease Journal

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Background: Published literature on central nervous system (CNS) coccidioidomycosis in children is limited. Here we describe a large case series of pediatric CNS coccidioidomycosis from a tertiary care center in an endemic region. Method: This is a retrospective case review of patients ≤21 years old with a diagnosis of CNS coccidioidomycosis from January 1, 2000, to December 31, 2018. Results: Thirty patients (median age 10.8 years) were identified and most (93%) were previously healthy. Fever (90%), headache (70%), vomiting (53%), and fatigue (57%) were the most common presenting clinical manifestations, with focal neurological signs/symptoms present in 14 (47%). The initial serum Coccidioides compliment fixation (CF) titer was ≤ 1:8 in 33%. Most patients had extra-axial brain involvement (83%) and seven (23%) had associated spinal cord disease. Shunt placement was required in 70% and 62% required revision. Fluconazole was the initial treatment in 22 (73%), with treatment failure occurring in 50%. Most patients (77%) stabilized and were maintained on suppressive therapy, 4 (13%) experienced relapses and/or progressive disease, and one (3%) died, while long-term neurological complications occurred in 17%. Conclusions: CNS coccidioidomycosis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers and hydrocephalus is common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed.

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Section: Discussionmentioning

confidence: 97%

Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series

Naeem

Laningham

Giglio

et al. 2022

Pediatric Infectious Disease Journal

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“…Few reports demonstrate rapidly disseminated infections in immunocompetent patients. Fatima et al reported an immunocompetent individual with early manifestations of CM who received early treatment that prevented neurological sequelae [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Persistent Headaches in an Avid Hiker: A Case of Chronic Coccidioidal Meningitis

Bies,

Hassan,

Prakash

et al. 2023

Cureus

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The clinical presentation, diagnosis, treatment, and complications of coccidioidal meningitis caused by the dimorphic pathogenic fungus Coccidioides (Coccidioides immitis and Coccidioides posadasii) have been well documented in the literature. Despite the abundance of literature concerning this disease manifestation, it is not very commonly seen in clinical practice, delaying its diagnosis and treatment and leading to devastating neurological sequelae. Therefore, considering this disease process as a potential diagnosis in endemic areas is important for appropriate and timely treatment.We present the case of a 26-year-old male who was found to have chronic coccidioidal meningitis on further investigation. The patient presented as a transfer for an abnormal head MRI with a three-month history of progressive occipital headaches and shortness of breath. Associated symptoms included transit vision loss, upper extremity numbness, night sweats, decreased appetite, and weight loss. Relevant risk factors were being a hiker and living in the southwest of Texas. The patient was started on empiric ceftriaxone and vancomycin. A repeat MRI showed leptomeningeal enhancement and acute infarcts in the left temporal lobe and lentiform nucleus. Cerebrospinal fluid (CSF) analysis showed pleocytosis with lymphocytic predominance, the presence of eosinophils, elevated protein level, and an extremely low glucose level. Further workup ruled out syphilis and tuberculosis.Therefore, considering his clinical presentation, risk factors, and workup results, ceftriaxone and vancomycin were discontinued, and high-dose oral fluconazole was started, which produced a marked clinical response within the next 48 hours. A CT thorax showed findings suggestive of pulmonary coccidioidomycosis, and Coccidioides serology in both serum and CSF specimens returned positive.

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“…The proportion of the population with these conditions is increasing, which means the number of persons at risk for severe coccidioidomycosis is also on the rise [ 28 ]. Apart from host status, severe disease does occur in people with no recognized immunocompromising disorder, too [ 29 ]. The potential for severe outcomes, especially among the increasing numbers of vulnerable and immunocompromised populations, is amplified when the diagnosis is delayed.…”

Section: Clinical Benefits Of Coccidioidomycosis As a Reportable Diseasementioning

confidence: 99%

Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America

Gorris

Ardon‐Dryer

Campuzano

et al. 2023

JoF

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Coccidioidomycosis (Valley fever) has been a known health threat in the United States (US) since the 1930s, though not all states are currently required to report disease cases. Texas, one of the non-reporting states, is an example of where both historical and contemporary scientific evidence define the region as endemic, but we don’t know disease incidence in the state. Mandating coccidioidomycosis as a reportable disease across more US states would increase disease awareness, improve clinical outcomes, and help antifungal drug and vaccine development. It would also increase our understanding of where the disease is endemic and the relationships between environmental conditions and disease cases. This is true for other nations in North and South America that are also likely endemic for coccidioidomycosis, especially Mexico. This commentary advocates for US state and territory epidemiologists to define coccidioidomycosis as a reportable disease and encourages disease surveillance in other endemic regions across North and South America in order to protect human health and reduce disease burden.

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A Case of Rapidly Progressive Coccidioidal Meningitis in an Immunocompetent Patient

Cited by 3 publications

References 9 publications

Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series

Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series

Persistent Headaches in an Avid Hiker: A Case of Chronic Coccidioidal Meningitis

Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America

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