Bouza E, Dreyer J S, Hewitt W L, Meyer R D
Medicine (Baltimore). 1981 May;60(3):139-72.
Clinical and laboratory features of 31 patients with coccidioidal meningitis seen from January 1964 through December 1976 with follow-up through 1979 are reported and data on 114 patients from the literature reviewed. History of exposure to C. immitis, a wide age range, and, in about one third, underlying conditions are noteworthy. Dissemination to the meninges usually occurs within the first few months although diagnosis is frequently delayed. Presenting symptoms and signs of coccidioidal meningitis are varied but signs of chronic meningitis or suggestion of hydrocephalus are prominent. Evidence of acute infection is unusual even with widespread disease. Diagnosis is usually made by demonstration of coccidioidal CF antibodies in the CSF although they are not found in all patients. Some show other direct evidence of C. immitis. Special diagnostic techniques such as CAT scanning for evidence of basilar meningitis or hydrocephalus are valuable. Amphotericin B remains the drug of choice despite the need for long-term therapy and the problems with intrathecal administration. Reservoirs are only occasionally useful but shunts are frequently lifesaving despite complications. Factors associated with a bad prognosis are hydrocephalus, non-Caucasian race, or presence of an underlying disease.
报告了1964年1月至1976年12月期间收治的31例球孢子菌性脑膜炎患者的临床和实验室特征，并对这些患者随访至1979年，同时回顾了文献中114例患者的数据。接触粗球孢子菌的病史、广泛的年龄范围以及约三分之一患者存在的基础疾病值得注意。虽然诊断常常延迟，但播散至脑膜通常发生在最初几个月内。球孢子菌性脑膜炎的症状和体征多种多样，但慢性脑膜炎体征或脑积水迹象较为突出。即使疾病广泛播散，急性感染的证据也不常见。诊断通常通过脑脊液中球孢子菌补体结合（CF）抗体的检测来确定，尽管并非所有患者都能检测到。一些患者显示出粗球孢子菌的其他直接证据。诸如计算机断层扫描（CAT）等特殊诊断技术对于发现基底脑膜炎或脑积水证据很有价值。尽管需要长期治疗且鞘内给药存在问题，但两性霉素B仍然是首选药物。贮液囊仅偶尔有用，但分流术尽管有并发症却常常能挽救生命。与预后不良相关的因素包括脑积水、非白种人种族或存在基础疾病。
