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Coccidioidal meningitis in non-AIDS patients. A case series at a Mexican neurological referral center
- Source :
- Clinical neurology and neurosurgery. 196
- Publication Year :
- 2019
-
Abstract
- Background Coccidioidal meningitis is a life-threatening condition and a diagnostic challenge in cases of chronic meningitis. It is associated to severe complications, like basal arachnoiditis, hydrocephalus, and secondary vasculitis. Objective To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center. Results The clinical records of 11 patients, predominantly males, were retrieved. Weight loss and night sweats were observed in 64 % of cases. Neurological signs included intracranial hypertension in 91 % of cases, altered alertness and meningeal syndrome in 72 %, and neuropsychiatric symptoms in 64 %. Mean CSF glucose levels were 30 ± 25 mg/dL, and pleocytosis ranged from 0 to 2218 cells/mm3. The diagnosis was confirmed by coccidioidal antigen latex agglutination in 91 % of cases. Radiological findings were hepatomegaly in 55 % of cases and pneumonia in 45 %. Neuroimaging findings included leptomeningitis in 73 % of cases, pachymeningitis in 45 %, and vascular involvement in 91 %. Less common findings included spinal cord lesion and mycotic aneurism, found in 18 % of cases. A molecular coccidioidal DNA test confirmed the predominance of Coccidioides immitis, detected in 64 % of cases. With respect to the clinical outcome, 46 % of patients died. The survivors suffered from sequels like chronic headache, cognitive alterations, and depression. Conclusions Coccidioidal meningitis is an entity with high mortality rates. More than one half of patients suffered disseminated disease. Although meningeal signs are not frequent in chronic meningitis, more than two-thirds of our patients showed mild nuchal rigidity. In addition, cerebral and cerebellar volume loss, associated with cognitive impairment and depression, was often observed in surviving patients during the clinical-radiological follow-up.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
Antifungal Agents
Coccidioides immitis
Neuroimaging
03 medical and health sciences
Young Adult
0302 clinical medicine
medicine
Humans
Disseminated disease
Pleocytosis
Mexico
Depression (differential diagnoses)
Retrospective Studies
Coccidioidomycosis
biology
Coccidioides
business.industry
Brain
General Medicine
Middle Aged
medicine.disease
biology.organism_classification
Hydrocephalus
Meningitis, Fungal
Pneumonia
Treatment Outcome
030220 oncology & carcinogenesis
Hypertension
Surgery
Female
Neurology (clinical)
Arachnoiditis
business
Vasculitis
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18726968
- Volume :
- 196
- Database :
- OpenAIRE
- Journal :
- Clinical neurology and neurosurgery
- Accession number :
- edsair.doi.dedup.....b199825184dd9e54d7c717a269be926e