{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:25:22Z","timestamp":1787729122732,"version":"build-2784847793"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background: Coccidioidomycosis meningitis (CM) is the most aggressive form of coccidioidomycosis, requiring lifelong antifungal treatment and often cerebrospinal fluid (CSF) diversion. Long-standing CM can be associated with spinal complications such as arachnoiditis. However, studies describing the frequency, clinical, and imaging characteristics of arachnoiditis in patients with CM are limited. Methods: We identified 133 patients with CM based on CSF culture, PCR, or serology between January 2010 and December 2020. Of these, 37 patients underwent spinal imaging. Data on demographics, risk factors, symptoms, antifungal therapy, surgical management, follow-up visits, adherence, serological trends, and imaging findings were reviewed. Results: Abnormal findings were observed in 30 of the 37 patients with CM who underwent spinal imaging. The imaging abnormalities noted in our study included leptomeningeal enhancement (53%), arachnoiditis (53%), syringomyelia (23%), cord signal abnormalities (10%), and osteomyelitis (7%). Of the 30 patients, 90% had symptoms, such as weakness, numbness, or urinary retention. The incidence of arachnoiditis in the present study was 12%. Higher initial CSF protein levels and intra cranial pressure were associated with a higher risk of developing arachnoiditis\/syringomyelia. Management of CM was challenging, as evidenced by shunt failure (46%), medication non-compliance (57%), and lack of adequate follow-up (60%). Persistent disabilities were noted in 62% of the patients. Conclusions: Patients with CM develop spinal complications such as arachnoiditis, or syringomyelia. Many cases may go undetected due to lack of symptoms in early stages. CM management challenges such as shunt failure, lack of follow-up care, and medication noncompliance, were frequent.<\/jats:p>","DOI":"10.3390\/jof8111180","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T02:44:32Z","timestamp":1667961872000},"page":"1180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Spinal Arachnoiditis in Patients with Coccidioidomycosis Meningitis\u2014Analysis of Clinical and Imaging Features"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8443-7095","authenticated-orcid":false,"given":"Geetha","family":"Sivasubramanian","sequence":"first","affiliation":[{"name":"Department of Infectious Disease, University of California, Fresno, CA 93701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurin","family":"Kadakia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Fresno, CA 93701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jani M.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, University of California, Fresno, CA 93701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Pervaiz","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, University of California, Fresno, CA 93701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqi","family":"Yan","sequence":"additional","affiliation":[{"name":"HSRI Biostatistics and Data Support Core, University of California, Merced, CA 95343, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Libke","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, University of California, Fresno, CA 93701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.idc.2021.03.010","article-title":"Coccidioidomycosis","volume":"35","author":"Bays","year":"2021","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1093\/mmy\/myy095","article-title":"Update on the Epidemiology of coccidioidomycosis in the United States","volume":"57","author":"McCotter","year":"2019","journal-title":"Med. Mycol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e00112-19","DOI":"10.1128\/CMR.00112-19","article-title":"Early Events in Coccidioidomycosis","volume":"33","author":"Donovan","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1086\/319203","article-title":"Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995\u20131996","volume":"32","author":"Rosenstein","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.idc.2015.10.008","article-title":"Coccidioidomycosis","volume":"30","author":"Stockamp","year":"2016","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Stevens, D.A. (1980). Coccidioidal Meningitis. Coccidioidomycosis: A Text, Springer.","DOI":"10.1007\/978-1-4757-1712-9"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11910-018-0824-8","article-title":"Coccidioidal Meningitis: A Review on Diagnosis, Treatment, and Management of Complications","volume":"18","author":"Johnson","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_8","first-page":"33","article-title":"Clinical presentation, radiological findings, and treatment results of coccidioidomycosis involving the spine: Report on 23 cases","volume":"95","author":"Wrobel","year":"2001","journal-title":"J. Neurosurg."},{"key":"ref_9","first-page":"e9304","article-title":"Spinal Coccidioidomycosis: A Complication from Medication Noncompliance","volume":"12","author":"Sakya","year":"2020","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.jocn.2013.07.040","article-title":"Rapidly progressive quadriparesis heralding disseminated coccidioidomycosis in an immunocompetent patient","volume":"21","author":"Tan","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jackson, N.R., Blair, J.E., and Ampel, N.M. (2019). Central Nervous System Infections Due to Coccidioidomycosis. J. Fungi, 5.","DOI":"10.3390\/jof5030054"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.2214\/AJR.12.9264","article-title":"Imaging spectrum of CNS coccidioidomycosis: Prevalence and significance of concurrent brain and spinal disease","volume":"200","author":"Lammering","year":"2013","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.3174\/ajnr.A5818","article-title":"Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients","volume":"39","author":"Crete","year":"2018","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.1016\/j.wneu.2020.03.135","article-title":"Shunt Treatment for Coccidioidomycosis-Related Hydrocephalus: A Single-Center Series","volume":"138","author":"Morshed","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/00006416-200305000-00010","article-title":"A comprehensive review of spinal arachnoiditis","volume":"22","author":"Wright","year":"2003","journal-title":"Orthop. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"299","DOI":"10.25259\/SNI_383_2022","article-title":"Spinal arachnoiditis and syringomyelia: Review of literature with emphasis on postinfectious inflammation and treatment","volume":"13","author":"Nadeem","year":"2022","journal-title":"Surg. Neurol. Int."},{"key":"ref_17","unstructured":"Peng, H., and Conermann, T. (2022). Arachnoiditis. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s100720300021","article-title":"Syringomyelia following Listeria meningoencephalitis: Report of a case","volume":"24","author":"Nardone","year":"2003","journal-title":"Neurol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/QCO.0000000000000669","article-title":"Subarachnoid neurocysticercosis: Emerging concepts and treatment","volume":"33","author":"Nash","year":"2020","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1093\/cid\/ciw739","article-title":"Spinal Arachnoiditis as a Complication of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Adults","volume":"64","author":"Panackal","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jocn.2021.01.052","article-title":"Management of syringomyelia associated with tuberculous meningitis: A case report and systematic review of the literature","volume":"87","author":"Kannapadi","year":"2021","journal-title":"J. Clin. Neurosci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e404","DOI":"10.1097\/MD.0000000000000404","article-title":"Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis","volume":"94","author":"Gupta","year":"2015","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1038\/sc.2015.58","article-title":"Spinal cord involvement in tuberculous meningitis","volume":"53","author":"Garg","year":"2015","journal-title":"Spinal Cord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"648","DOI":"10.2214\/AJR.16.16704","article-title":"Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review","volume":"209","author":"Anderson","year":"2017","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1093\/cid\/ciac478","article-title":"Controversies in the Management of Central Nervous System Coccidioidomycosis","volume":"75","author":"Thompson","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/cid\/ciw538","article-title":"Executive Summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MD.0b013e3181f378a8","article-title":"Coccidioidal meningitis: Clinical presentation and management in the fluconazole era","volume":"89","author":"Mathisen","year":"2010","journal-title":"Medicine"},{"key":"ref_28","first-page":"519","article-title":"Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis","volume":"64","author":"Ho","year":"2017","journal-title":"Clin. Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/11\/1180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:12:50Z","timestamp":1760145170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/11\/1180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,8]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jof8111180"],"URL":"https:\/\/doi.org\/10.3390\/jof8111180","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,8]]}}}