Neurology: Case of the Month

Test Yourself — Patient 70

Coccidioides Immitis Meningoencephalitis

1. Nearly all coccidioidal infections are thought to arise from WHICH of the following routes of entry:
   • [ A ] Inhalation
   • [ B ] Exposure to blood products
   • [ C ] Transcutaneous exposure
   • [ D ] Ingestion of contaminated food
2. All of the following statements regarding coccidioidal meningitis are true EXCEPT:
   • [ A ] Definite diagnosis can be made by culture of CSF.
   • [ B ] Definite diagnosis can be made by stains of brain or meningeal tissue.
   • [ C ] Definite diagnosis can be made by detection of IgG antibodies specific to C. immitis in the serum.
3. Typical findings in coccidioidal CNS infection might include all of the following EXCEPT:
   • [ A ] CSF white blood cell count of 2,900 /mL.
   • [ B ] CSF glucose of 23 mg/dL.
   • [ C ] CSF opening pressure of 15 cm H2O.
   • [ D ] CSF opening pressure of 24 cm H2O.
4. Signs and symptoms in coccidioidal CNS infection can arise from WHICH of the following:
   • [ A ] Hydrocephalus
   • [ B ] Meningeal vasculitis with cerebral infarctions
   • [ C ] Mass effect from abscess or granuloma
   • [ D ] All of the above
5. All of the following statements about treatment of coccidioidal meningitis are true EXCEPT:
   • [ A ] Fluconazole monotherapy is often effective treatment.
   • [ B ] Many patients will require lifelong treatment.
   • [ C ] Clinical recurrence after cessation of treatment is rare.
   • [ D ] Amphotericin B is a rational choice of therapy for selected patients.

 

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