Coccidioidal meningitis in non-AIDS patients. A case series at a Mexican neurological referral center

Cárdenas, Graciela; Aristizábal, Santiago; Salinas, Citlaltepetl; Delgado-Hernández, Rosa Delia; Ángeles-Morales, Verónica; Soto-Hernández, José Luís; Castañón-Olivares, Laura Rosío; Hernández, F. C.

doi:10.1016/j.clineuro.2020.106011

Cited by 9 publications

(5 citation statements)

References 18 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: 98%

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: 98%

Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series

Naeem

Laningham

Giglio

et al. 2022

Pediatric Infectious Disease Journal

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“…Deep infarcts and communicating hydrocephalus are also associated findings. The neuroimaging of CM also shows hydrocephalus, periventricular edema, meningeal enhancement abnormalities, leptomeningitis, pachymeningitis, cranial nerve enhancement, and vasculitic abnormalities [ 21 ]. Intense enhancement regions tend to decrease during therapy.…”

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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“…4 Bacterial causes include tuberculosis, Treponema , Borrelia , and contiguous spread from the sinuses or ears (especially Pseudomonas ), whereas fungal causes include Aspergillus , Coccidioides , Histoplasma , and Cryptococcus . 2,5,6 Finally, intracranial hypotension may be iatrogenic, after lumbar puncture, neurosurgery, or overshunting. 4 Spontaneous intracranial hypotension (SIH) occurs in the context of a spinal CSF leak because of ventral dural tear, meningeal nerve root diverticulum, or CSF-venous fistula.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: New-Onset Diplopia and Headache in a Patient With Metastatic Breast Cancer

et al. 2023

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Coccidioidal meningitis in non-AIDS patients. A case series at a Mexican neurological referral center

Cited by 9 publications

References 18 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

Clinical Reasoning: New-Onset Diplopia and Headache in a Patient With Metastatic Breast Cancer

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