Hyphal Forms in the Central Nervous System of Patients with Coccidioidomycosis

Abstract

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).

Innovation of the Parasitic Cycle of Coccidioides spp.

“…In addition, we describe different mycelial forms and chronic pulmonary coccidioidomycosis in patients with diabetes ( Figure 1a). Also, these mycelial forms were described in chronic and cavitary pulmonary, ventriculoperitoneal shunt, and different cases of Central nervous system (CNS) infections by other researchers (Dolan et al,1992;Hagman et al, 2000;Heidi et al, 2000;Klenschmidt-DeMasters et al, 2000;Meyer et al, 1982;Muñoz et al, 2004;Muñoz-Hernández et al 2008;Nosanchuk et al, 1998;Wages et al, 1995;Zepeda et al, 1998).…”

Coccidioidal meningitis: Update on epidemiology, clinical features, diagnosis, and management

“…Several shunts are available, and all can be complicated by malfunction or migration, bacterial infection, and dissemination of the coccidioidal infection via the shunt [7]. The foreign material that composes shunts may also be associated with growth of the mycelial form of the dimorphic fungus, which increases the risk of device obstruction [19].…”

“…These organisms can be identifi ed in tissue using silver, hematoxylin-eosin, and periodic acid-Schiff stains. Rarely, CSF can show mold forms of Coccidioides; such hyphal forms have been reported with [19,23] or without [24] the presence of foreign material (eg, ventricular shunts). Demonstration of mycelial forms are not suffi ciently specifi c to be diagnostic and must be confi rmed by culture.…”

Coccidioïdomycose révélée par des lésions cutanées spécifiques survenues après une dérivation ventriculo-cardiaque pour méningite chronique

“…Elle impose une dérivation rapide du LCR car le pronostic est grave [12]. D'autres complications neurologiques comme des vascularites cérébrales [15], des thrombophlébites cérébrales, des abcès cérébraux ont été rapportés. Le diagnostic doit être évoqué devant une méningite lymphocytaire avec hypoglycorachie, la protéinorachie étant souvent > 1,5 g/L.…”

“…Parfois le LCR est à prédominance neutrophilique [10]. Le diagnostic repose sur la réalisation de sérologies spécifiques qui peuvent être les seules à permettre le diagnostic des formes méningées isolées [10,14,15], le champignon étant rarement isolé dans le LCR [13,15]. Les cultures du champignon sous la forme filamenteuse sont dangereuses à manipuler car les arthrospores sont très volatiles.…”