1/18. coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia.To our knowledge we report the first case of meningitis from coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
2/18. Hyphal forms in the central nervous system of patients with coccidioidomycosis.coccidioides immitis is a dimorphic fungus that grows as a filamentous mold in soil and as a spherule at human body temperature. The hyphal or soil form is found rarely in human tissue. We report 5 cases of coccidioidomycosis in which hyphae were found in brain tissue or spinal fluid. The presence of central nervous system plastic devices appears to be associated with morphological reversion to the saprophytic form. This reversion has implications for diagnosis and therapy and may increase the risk of obstruction of the device(s).- - - - - - - - - - ranking = 4.9390163003564keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
3/18. female genital coccidioidomycosis (FGC), Addison's disease and sigmoid loop abscess due to coccidioides immites; case report and review of literature on FGC.We describe a woman with unusual complications of infection with coccidioides immitis--infection of the genital tract and adrenal insufficiency. The patient also had intestinal coccidioidomycosis (cocci) in conjunction with presumed pulmonary, and asymptomatic central nervous system cocci. To our knowledge, concurrent FGC, intestinal and adrenal cocci have not been reported previously. A medline review from 1966-1997 revealed only 1 case of adrenal insufficiency due to cocci. FGC is rare; we identified 12 reported cases since 1929. No combination of investigations or clinical features is sensitive enough to predict FGC. diagnosis is usually made after microscopy of surgical specimens. FGC presents either as tubo-ovarian disease or endometritis. Treatment generally involves surgical excision and antifungal agents. We hypothesize that an initial trial of antifungals may obviate the need for surgery.- - - - - - - - - - ranking = 0.98475407508909keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/18. Successful treatment of coccidioidal meningitis with voriconazole.A previously healthy 47-year-old man with coccidioidal meningitis had fluconazole treatment failure and developed severe symptoms, multiple cranial nerve palsies, and brain-stem inflammation visible on magnetic resonance imaging (MRI). High-dose voriconazole therapy resulted in gradual resolution of almost all signs and symptoms, normalization of cerebrospinal fluid, and clearing of brain-stem edema seen on MRI. The patient had photosensitivity after 10 weeks of treatment, but this improved when the voriconazole dose was lowered. Continuous voriconazole therapy kept coccidioidal meningitis in complete remission in this patient for >2 years.- - - - - - - - - - ranking = 0.030491849821821keywords = brain (Clic here for more details about this article) |
5/18. coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies.coccidioidomycosis is a fungal disease with protean manifestations endemic to the Lower Sonoran life Zone, which includes the hot deserts of the southwestern united states and areas of mexico. Two hundred and twenty-three patients were found to have coccidioidomycosis at our institution from 1994-2002, the largest reported cohort of coccidioidomycosis patients since the 1950s. Of these patients, 58% presented with isolated pulmonary disease, 14% had high (>1:16) complement fixation titers without clear evidence of dissemination, 22% had definite disseminated disease, and 5% had unclassified disease. Enzyme immunoassay was a reliable diagnostic tool in those with symptomatic disease, but had a low specificity in those who were asymptomatic. Complement fixation titers of > or =1:16 were associated with dissemination to bone or skin but were not helpful in evaluating central nervous system disease. Thirteen percent of patients with high complement fixation titers (>1:16) without clear evidence of dissemination on presentation and 7% of those with isolated pulmonary disease eventually progressed to disseminated disease; 30% of Filipino patients with pulmonary disease progressed to disseminated disease. Nonwhite race was a predictor for dissemination; African American patients more often developed disseminated bony disease while Filipinos were more likely to develop cutaneous or central nervous system disease. Relapse of disseminated coccidioidomycosis occurred in 24% of patients; the risk was highest (71%) among those with central nervous system disease. Azole therapy was generally inferior to amphotericin b in disseminated disease. Predictors of permanent disability included African American or Filipino race, central nervous system disease, and bony disease.- - - - - - - - - - ranking = 3.1769032894318keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/18. Vasculitic and encephalitic complications associated with coccidioides immitis infection of the central nervous system in humans: report of 10 cases and review.Six cases of apparent and four cases of histopathologically confirmed vasculitis of the central nervous system (CNS), including one case of histopathologically documented vasculitis with encephalitis associated with coccidioidal meningitis (CM), are presented. Vasculitic complications included changes in mental status as well as stroke-like findings of aphasia, hemianopsia, and hemiparesis. Seven patients died. Vasculitic complications were unanticipated and often abrupt in onset, and delayed therapeutic intervention was characteristic. The diagnosis of vasculitis/encephalitis due to coccidioides immitis infection must be based on clinical judgment, since serum antibody titers, cerebrospinal fluid findings, and initial radiological studies are not always helpful. Institution of both intravenous and intracisternal administration of amphotericin b and possibly concomitant intravenous administration of dexamethasone may be warranted in situations in which the association of C. immitis with CNS vasculitis or encephalitis appears likely before serologic or cultural confirmation of C. immitis infection involving the CNS is available.- - - - - - - - - - ranking = 4.9237703754454keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/18. Unusual presentations of coccidioidomycosis: a case series and review of the literature.coccidioidomycosis is an emerging fungal infection of the southwestern united states. Although coccidioides species infections are usually asymptomatic or result in a mild, flu-like illness, disseminated disease may occur in 1% of cases. While extrapulmonary disease usually involves the skin, central nervous system, bones, or joints, coccidioidomycosis is a great imitator, with the ability to infect any tissue or organ. Cases may be diagnosed outside of endemic areas, hence providers worldwide should be aware of the broad range of manifestations of coccidioidomycosis. We present a case series of unusual presentations of coccidioidomycosis including serous cavity infections with cases of pericarditis, empyema, and peritonitis, as well as unusual abscesses involving the retropharyngeal space and gluteal musculature. We provide a complete review of the literature and summarize the clinical presentations, diagnoses, and treatments of these rare forms of disseminated coccidioidomycosis.- - - - - - - - - - ranking = 0.98475407508909keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/18. Multiple intracranial aneurysms due to coccidioides immitis infection. Case report.True mycotic (fungal) aneurysms are distinctly uncommon. The case of a young woman with multiple intracranial aneurysms of coccidioides immitis origin is presented. coccidioides immitis organisms are not uncommon central nervous system pathogens and usually cause basilar meningitis and hydrocephalus. There are no previous reports of a coccidioidal mycotic aneurysm. The management of intracranial coccidioidomycosis and fungal aneurysms is reviewed.- - - - - - - - - - ranking = 0.98475407508909keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/18. Treatment of central nervous system fungal infection with ketoconazole.Two patients with fungal infection of the central nervous system (coccidioidal meningitis and cerebral histoplasmomas) were treated with ketoconazole for 30 months. Both responded to dosages substantially less than those described previously for similar infections. Neither patient experienced any significant adverse effects from the prolonged therapy.- - - - - - - - - - ranking = 4.9237703754454keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/18. Combined intravenous miconazole and intrathecal amphotericin b for treatment of disseminated coccidioidomycosis.A patient received a previously unreported combination of intravenous miconazole and intrathecal amphotericin b for the treatment of disseminated coccidioidomycosis with central nervous system involvement. After first having been treated with amphotericin b, followed by a course of miconazole therapy, the patient responded with remarkable clinical and serologic improvement to the combination of intrathecal amphotericin b and intravenous miconazole. The combination should be considered in the treatment of disseminated coccidioidomycosis with central nervous system involvement.- - - - - - - - - - ranking = 1.9695081501782keywords = central nervous system, nervous system (Clic here for more details about this article) |
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