Description
- Abstract:
- Background: Coccidioides immitis and Coccidioides posadasii are dimorphic fungi endemic to the U.S. Southwest. Inhaled arthroconidia cause pulmonary disease that can disseminate to the central nervous system and produce meningitis. Because presentations and complications are variably reported, we reviewed the literature to characterize common symptoms, CNS sequelae, and management approaches. Methods: We searched the Rocky Vista University Frank Ames Mitchell Memorial Library for reports of disseminated coccidioidomycosis with CNS involvement. Twenty-one peer reviewed studies from 1961 to 2023 met inclusion criteria. Results: The most frequent presenting symptoms were headache and fever, followed by nausea and vomiting. Additional findings included nuchal rigidity, ocular motor abnormalities such as diplopia and abducens (CN VI) palsy, and cutaneous lesions. Exposure history, including residence or travel in the Southwest, often aided recognition. The leading CNS complication was hydrocephalus, about 55 percent of cases. Altered mental status occurred in about 30 percent, and CNS vasculitis or vasospasm in about 25 percent, sometimes with focal deficits such as expressive aphasia, facial droop, or hemiparesis. Rare subarachnoid hemorrhage from mycotic aneurysm was reported. Management most often involved cerebrospinal fluid diversion with ventriculoperitoneal shunt or external ventricular drain to control intracranial pressure. Dehydration therapy was occasionally used. Corticosteroids were described for vasculitis, and mental status often improved as complications were treated. Discussion and conclusion: Clinicians may consider coccidioidal meningitis in patients with headache, fever, and gastrointestinal symptoms who have exposure to the Southwest. Screening for intracranial hypertension, including papilledema or CN VI palsy with diplopia, could be helpful. When intracranial pressure is suspected, early neuroimaging before lumbar puncture may be prudent, and neurosurgical consultation for cerebrospinal fluid diversion can be considered. We suggest that quantifying the documented prevalence of coccidioidal CNS sequelae will improve clinician awareness of characteristic complications and may support earlier recognition and treatment.
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Citation
Williamson, Carter, Awa, Joseph, and Kinder, Pamela,
"Clinical Presentations of Disseminated Coccidioidomycosis-Induced Meningitis: A Systematic Review of the Symptoms, Signs, Complications, and Management Strategies"
(2025).
Student Neurosurgery/Neurology Research Conference.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/13w5-r485
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Student Neurosurgery/Neurology Research Conference
Brown University Department of Neurosurgery and Department of Neurology and Warren Alpert Medical School annually hosts the Student Neurosurgery/Neurology Research Conference, a national conference for medical students conducting research in neurosurgery/neurology or related neuroscience fields....