1/8. An unusual complication of an open-head injury: coccidioidal meningitis.A case of coccidioidal meningitis following an open-head injury is presented. A 6-year-old boy was ejected from a motor vehicle as it was driven over a cliff, resulting in a severe open-skull fracture with grossly contaminated wounds. The accident occurred in an area in which coccidioidomycosis is endemic, and the causative agent, coccidioides immitis, is found in high concentration in the soil. In addition to fracture reduction, the child received a course of intrathecal and intravenous amphotericin and achieved a satisfactory clinical response.- - - - - - - - - - ranking = 1keywords = immitis (Clic here for more details about this article) |
2/8. Treatment of coccidioidomycosis with ketoconazole: clinical and laboratory studies of 18 patients.ketoconazole was given to 18 patients with coccidioidomycosis. Fourteen had received prior antifungal chemotherapy with amphotericin b, miconazole, or both. Ten patients had pulmonary disease, two had meningitis, and six had extrameningeal disseminated disease. The initial dose of ketoconazole was 200 mg per day; it was later increased to 400 mg per day for some patients. All strains of Coccididioides immitis tested were sensitive to ketoconazole. Approximately 2-4 hr after an oral dose of 200 mg of ketoconazole, levels of the drug in blood peaked at approximately 2 micrograms/ml. Higher concentrations in blood were achieved with a 400-mg dose. Improvement was measured by physical examination, conversion of cultures previously positive for C. immitis to negative, decrease in erythrocyte sedimentation rate by 50%, and decrease in titer of complement fixation antibody by two or more dilutions. One patient died after one week of treatment with ketoconazole and could not be evaluated; two other patients with coccidioidal meningitis could not be evaluated. Six of nine patients with pulmonary disease showed radiographic improvement, and their sputum cultures, which had been positive, became negative. Four of the six patients with disseminated disease improved. There were few adverse reactions to ketoconazole, which can be safely administered for prolonged periods to patients with coccidioidomycosis. These findings suggest that ketoconazole may be effective for treatment of this disease and indicate that trials comparing the efficacy of ketoconazole with that of amphotericin b are warranted.- - - - - - - - - - ranking = 2keywords = immitis (Clic here for more details about this article) |
3/8. Disseminated coccidioidomycosis: clinical, immunologic and therapeutic aspects.A patient with disseminated coccidioidomycosis initially had pulmonary and skin manifestations and survived for 14 years before dying of meningitis due to coccidioides immitis. In addition to several courses of amphotericin b therapy the patient received injections of transfer factor derived from appropriate donors and miconazole nitrate therapy. The immunologic defence mechanisms of the patient during the course of his disease were studied and the possibility of a cell-mediated immunologic defect, potentially reversible by transfer factor, was demonstrated.- - - - - - - - - - ranking = 1keywords = immitis (Clic here for more details about this article) |
4/8. Juxtapapillary choroiditis associated with chronic meningitis due to coccidioides immitis.A 73-year-old man had chronic meningitis of uncertain origin. Ophthalmologic examination revealed juxtapapillary choroiditis with an associated localized serous retinal detachment. Subsequent laboratory evaluation demonstrated absent serum complement-fixing antibody titers to coccidioides immitis, but serological examination of the CSF demonstrated an antibody titer of 1:2. The final diagnostic impression was that of chronic meningitis in association with juxtapapillary choroiditis due to C immitis.- - - - - - - - - - ranking = 6keywords = immitis (Clic here for more details about this article) |
5/8. coccidioides immitis meningitis with arthroconidia in cerebrospinal fluid: report of the first case and review of the arthroconidia literature.The authors report the first case in which the spherules and arthroconidia of coccidioides immitis were identified from an indwelling cerebrospinal fluid reservoir. The organism was recovered in culture. Present as isolated meningitis, the patient's infection disseminated over a 12-year period despite intrathecal and intravenous administration of amphotericin b. The unusual findings in this patient are compared with findings in 95 cases of infections containing arthroconidia reported since 1940. Arthroconidia is most likely to be found in the tissues of white male patients who are in the third or fourth decade of life and have pulmonary lesions.- - - - - - - - - - ranking = 5keywords = immitis (Clic here for more details about this article) |
6/8. Coccidioidal meningitis. An analysis of thirty-one cases and review of the literature.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.- - - - - - - - - - ranking = 2keywords = immitis (Clic here for more details about this article) |
7/8. Coccidioidal meningitis complicated by cerebral arteritis and infarction.A case of coccidioidal meningitis with cerebral arteritis in a nonendemic area is reported. Interesting clinical features were the difficulties in clinical diagnosis, hydrocephalus, and neurological deficits. An autopsy revealed chronic basal meningitis, cerebral arteritis, cerebral infarcts, hydrocephalus, and an old solitary pulmonary granuloma all due to coccidioides immitis. The rare occurrence of cerebral arteritis due to C. immitis and clinicopathological correlations are discussed.- - - - - - - - - - ranking = 2keywords = immitis (Clic here for more details about this article) |
8/8. coccidioides immitis presenting as a hyphal form in a ventriculoperitoneal shunt.We report a case of meningitis in a 31-year-old man caused by coccidioides immitis, where the organism was observed growing in the cerebrospinal fluid exclusively as hyphae. This unusual morphology was seen in fluid obtained from a ventriculoperitoneal shunt. Only C immitis was cultured. Its identity was confirmed by both dna probes and standard culture techniques. To our knowledge this is the second report of C immitis taking a hyphal form in cerebrospinal fluid. coccidioides immitis should be considered in the differential diagnosis when hyphal forms are seen in body fluids. The diagnosis can be hastened by using dna probes, which enhance patient therapy and worker safety.- - - - - - - - - - ranking = 8keywords = immitis (Clic here for more details about this article) |