Last Updated: October 1, 2018
- Coccidioides immitis is a dimorphic fungus endemic to the southwestern US and regions of Mexico and Central and South America
- Primary infection occurs in the lungs after inhalation of airborne arthrospores
- Up to 5% of patients develop disseminated disease with CNS involvement being the most frequent and severe manifestation
- Mycelial form known to grow in the soil and produces spores that become airborne with disturbance of the soil
- Inhalation of the spores leads to pulmonary infection
- Signs and Symptoms
- Headache, nausea, vomiting, and altered mental status with concurrent pulmonary symptoms, septic shock and fungemia
Age and Gender
- No age or gender predilection
- Mean survival time
- Without treatment – 4 months
- With treatment (amphotericin B) – 21 months
- Mean survival time
- General features
- Most common presentation is meningitis with a propensity for the basal cisterns
- Hydrocephalus, infarctions, vasculitis, parenchymal or parameningeal masses and abscesses, periventricular white matter abnormalities and spinal arachnoiditis
- Important to perform spinal imaging because spinal involvement is common and may lead to change in management
- Ill-defined areas of hypoattenuation with intermixed hemorrhage
- Hydrocephalus, herniation
- Ill-defined hypointense regions
- Ill-defined hyperintense regions with possible hypointense rim
- Restriction along the wall of the abscess
- Hypointense signal in the setting of hemorrhage
- Meningeal enhancement in the setting of meningitis
- If cerebral parenchymal involvement, there will be variable enhancement
- Standard protocol MR (including DWI) with intravenous contrast
- Similar to other infectious processes, when walled off will be difficult to distinguish from other ring enhancing lesions. However, when presented with basilar cistern involvement, coccidioidomycosis should be included in your differential with tuberculosis and other granulomatous processes such as sarcoidosis.
For more information, please see the corresponding chapter in Radiopaedia.
Contributor: Sean Dodson, MD
Gupta NA, et al. Imaging Manifestations of Primary and Disseminated Coccidioidomycosis. Applied Radiology. Feb 2015; 9-21.
Lammering JC, et al. Imaging Spectrum of CNS Coccidioidomycosis: Prevalence and Significance of Concurrent Brain and Spinal Disease. AJR. 2013; 200:1334-46.
Starkey J, et al. MRI of CNS Fungal Infections: Review of Aspergillosis to Histoplasmosis and Everything in Between. Clin Neuroradiol. 2014; 24(3):217-30.
Wrobel CJ, et al. MR Findings in Acute and Chronic Coccidioidomycosis Meningitis. AJNR. 1992; 13:1241-45.
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