Drake Kendra W, Adam Rodney D
Departments of Neurology, Medicine, and Immunobiology, University of Arizona College of Medicine, Tucson, AZ 85724-5039, USA.
Neurology. 2009 Nov 24;73(21):1780-6. doi: 10.1212/WNL.0b013e3181c34b69.
Coccidioides species are the most common etiologic agents of chronic meningitis in regions endemic for coccidioidomycosis. Occasionally, even short-term travel to endemic regions results in the acquisition of meningeal disease, so awareness of this complication of coccidioidomycosis is important even in nonendemic areas. The prognosis depends on the early recognition and treatment of the disease, so it is important to be familiar with the varied clinical manifestations, risk factors associated with meningeal involvement, diagnostic challenges, and therapeutic modalities.
We performed a retrospective analysis of 71 cases with coccidioidomycosis involving the CNS seen from 1996 to 2007 at a referral medical center in southern Arizona.
The only presenting symptom found in the majority of patients was headache. Those who were immunocompromised (most commonly HIV/AIDS and chronic steroid therapy) were at increased risk, but diabetics were not at increased risk. There was a preponderance of males (2:1) and people of Hispanic, African, and Asian (especially Pacific Isles) background. CSF anticoccidioidal antibody and culture were frequently negative on presentation, but in these cases, the serum antibody test was usually positive. Imaging studies were helpful in two thirds of cases, most commonly demonstrating basilar meningitis or hydrocephalus, which frequently required ventriculoperitoneal shunting. Most were treated with fluconazole, and prognosis was good for most of those who remained on treatment.
Coccidioidal meningitis remains a diagnostic challenge, but the diagnosis can usually be made successfully when coccidioidal serum and CSF antibodies and cultures are combined with appropriate imaging studies.
球孢子菌属是球孢子菌病流行地区慢性脑膜炎最常见的病原体。偶尔，即使短期前往流行地区也会导致脑膜疾病，因此即使在非流行地区，了解球孢子菌病的这种并发症也很重要。预后取决于疾病的早期识别和治疗，所以熟悉其多样的临床表现、与脑膜受累相关的危险因素、诊断挑战及治疗方式很重要。
我们对1996年至2007年在亚利桑那州南部一家转诊医疗中心就诊的71例累及中枢神经系统的球孢子菌病病例进行了回顾性分析。
大多数患者唯一的首发症状是头痛。免疫功能低下者（最常见的是艾滋病毒/艾滋病和长期接受类固醇治疗）风险增加，但糖尿病患者风险未增加。男性占多数（2:1），且以西班牙裔、非洲裔和亚洲裔（尤其是太平洋岛屿裔）背景的人居多。脑脊液抗球孢子菌抗体和培养在初诊时常常为阴性，但在这些病例中，血清抗体检测通常为阳性。影像学检查在三分之二的病例中有所帮助，最常见的表现是基底脑膜炎或脑积水，这常常需要进行脑室腹腔分流术。大多数患者接受氟康唑治疗，大多数持续接受治疗的患者预后良好。
球孢子菌性脑膜炎仍然是一个诊断难题，但当结合球孢子菌血清和脑脊液抗体及培养结果与适当的影像学检查时，通常能够成功做出诊断。
