Infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Mexico.
Infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Mexico.
Clin Neurol Neurosurg. 2020 Sep;196:106011. doi: 10.1016/j.clineuro.2020.106011. Epub 2020 Jun 15.
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.
To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center.
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/mm. 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.
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.
球孢子菌性脑膜炎是一种危及生命的疾病，也是慢性脑膜炎的诊断难题。它与严重的并发症有关，如基底蛛网膜炎、脑积水和继发性血管炎。
介绍墨西哥神经学转诊中心的一项为期 20 年的球孢子菌性脑膜炎病例回顾性临床系列研究。
检索到 11 例患者的临床记录，主要为男性。64%的病例出现体重减轻和盗汗。神经系统体征包括颅内压升高 91%，意识改变和脑膜综合征 72%，神经精神症状 64%。平均 CSF 葡萄糖水平为 30±25mg/dL，细胞增多症范围为 0-2218 个/mm。91%的病例通过球孢子菌抗原乳胶凝集试验确诊。放射学发现 55%的病例有肝肿大和 45%的病例有肺炎。神经影像学发现包括脑膜炎 73%，脑脊髓膜炎 45%，血管受累 91%。较少见的发现包括脊髓病变和真菌性动脉瘤，分别见于 18%的病例。分子球孢子菌 DNA 检测证实了 Coccidioides immitis 的优势，在 64%的病例中检测到。关于临床结果，46%的患者死亡。幸存者患有慢性头痛、认知改变和抑郁等后遗症。
球孢子菌性脑膜炎是一种死亡率较高的疾病。超过一半的患者患有播散性疾病。尽管脑膜体征在慢性脑膜炎中并不常见，但我们超过三分之二的患者表现出轻度颈部僵硬。此外，在临床-放射学随访期间，经常观察到存活患者的大脑和小脑体积减少，伴有认知障碍和抑郁。
