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Central Nervous System Infections Due to Coccidioidomycosis

Division of Infectious Diseases, Mayo Clinic in Arizona, Phoenix, AZ 85054, USA
University of Arizona College of Medicine, Tucson, AZ 85724, USA
Author to whom correspondence should be addressed.
J. Fungi 2019, 5(3), 54;
Received: 31 May 2019 / Revised: 20 June 2019 / Accepted: 26 June 2019 / Published: 28 June 2019
(This article belongs to the Special Issue Fungal Infections of the Central Nervous System)
Coccidioidomycosis is a common infection in the western and southwestern United States as well as parts of Mexico and Central and South America and is due to the soil-dwelling fungi Coccidioides. Central nervous system (CNS) infection is an uncommon manifestation that is nearly always fatal if untreated. The presentation is subtle, commonly with headache and decreased mentation. The diagnosis should be considered in patients with these symptoms in association with a positive serum coccidioidal antibody test. The diagnosis can only be established by analysis of cerebrospinal fluid (CSF), which typically demonstrates a lymphocytic pleocytosis, hypoglycorrhachia, elevated protein, and positive CSF coccidioidal antibody. Cultures are infrequently positive but a proprietary coccidioidal antigen test has reasonable sensitivity. Current therapy usually begins with fluconazole at 800 mg daily but other triazole antifungals also have efficacy and are often used if fluconazole fails. Triazole therapy should be lifelong. Intrathecal amphotericin B, the original treatment, is now reserved for those in whom triazoles have failed. There are several distinct complications of CNS coccidioidal infection, the most common of which is hydrocephalus. This is nearly always communicating and requires mechanical shunting in addition to antifungal therapy. Other complications include cerebral vasculitis, brain abscess, and arachnoiditis. Management of these is difficult and not well established. View Full-Text
Keywords: Coccidioides; coccidioidomycosis; central nervous system; meningitis; brain abscess; fungal infections Coccidioides; coccidioidomycosis; central nervous system; meningitis; brain abscess; fungal infections
MDPI and ACS Style

Jackson, N.R.; Blair, J.E.; Ampel, N.M. Central Nervous System Infections Due to Coccidioidomycosis. J. Fungi 2019, 5, 54.

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