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• W194963463 abstract "Untreated coccidioidal meningitis is a uniformly fatal disease. Successful therapy is possible and, when instituted early in the course of the illness, may prevent considerable morbidity and mortality. However, early diagnosis remains a major problem. Coccidioidal meningitis has been diagnosis in nine patients who have been treated at this hospital. Delay in diagnosis ranged from one to sixteen months (mean, seven months) in these patients. Each presenting history was analyzed in retrospect for factors that contributed to the delay in diagnosis. The presenting symptoms, which were usually vague and chronic, did not suggest serious disease, and frequently were thought to be due to psychiatric illness. The initial physical examination was not diagnostically helpful. The illness often became manifest in a nonendemic area. Less than halt of these patients had a prior history of nonmeningitic coccidioidomycosis. The coccidioidin skin test was invariably negative in these patients. The initial spinal fluid examination in all nine patients was grossly abnormal with plecytosis, increased protein and decreased glucose. This prompted further studies that led to the diagnosis shortly thereafter. Early examination of the spinal fluid in patients who present with vague protracted neurologic and psychiatric syndromes should be performed to exclude this disease and other treatable chronic granulomatous meningitides. Untreated coccidioidal meningitis is a uniformly fatal disease. Successful therapy is possible and, when instituted early in the course of the illness, may prevent considerable morbidity and mortality. However, early diagnosis remains a major problem. Coccidioidal meningitis has been diagnosis in nine patients who have been treated at this hospital. Delay in diagnosis ranged from one to sixteen months (mean, seven months) in these patients. Each presenting history was analyzed in retrospect for factors that contributed to the delay in diagnosis. The presenting symptoms, which were usually vague and chronic, did not suggest serious disease, and frequently were thought to be due to psychiatric illness. The initial physical examination was not diagnostically helpful. The illness often became manifest in a nonendemic area. Less than halt of these patients had a prior history of nonmeningitic coccidioidomycosis. The coccidioidin skin test was invariably negative in these patients. The initial spinal fluid examination in all nine patients was grossly abnormal with plecytosis, increased protein and decreased glucose. This prompted further studies that led to the diagnosis shortly thereafter. Early examination of the spinal fluid in patients who present with vague protracted neurologic and psychiatric syndromes should be performed to exclude this disease and other treatable chronic granulomatous meningitides." @default.
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• W194963463 date "1970-09-01" @default.
• W194963463 modified "2023-09-23" @default.
• W194963463 title "Coccidoidal meningitis" @default.
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• W194963463 doi "https://doi.org/10.1016/s0002-9343(70)80028-6" @default.
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