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Eosinophilic pleocytosis in coccidioidal meningitis: frequency and significance
A S Ragland1, E Arsura, Y Ismail
1Department of Medicine, Kern Medical Center, Bakersfield, California 93305.
Purpose:
Coccidioidal meningitis (CM) is a major source of morbidity and mortality in endemic regions. The diagnosis of CM is a clinical challenge. Eosinophilic pleocytosis (EP) is an uncommon finding and present in a relatively limited number of conditions. In order to determine the frequency and the prognostic significance of EP in CM, we conducted the present study.
Patients And Methods:
Retrospective chart review of all patients diagnosed as having CM between 1986 and 1991 at Kern Medical Center. All patients had clinical and cerebrospinal fluid (CSF) findings confirmatory of CM.
Results:
Nineteen patients (70%) in the study group had EP, and of these, 8 patients (30%) met the criteria for eosinophilic meningitis (greater than or equal to 10 eosinophils/mm3). No correlation was found between EP and age, sex, race, results of complement fixation test for coccidioidal antigen in CSF or serum, peripheral eosinophilia, or outcome.
Conclusion:
The presence of EP is a frequent observation in CM. Although we did not demonstrate any prognostic correlation with EP, this finding is of major diagnostic significance and its presence should bring attention to the diagnosis of CM.
Insights
Eosinophilic pleocytosis is common in coccidioidal meningitis (CM), a serious infection. While not a direct predictor of outcome, its presence strongly suggests CM, aiding diagnosis.
Area of Science:
- Infectious Diseases
- Neurology
- Clinical Medicine
Background:
- Coccidioidal meningitis (CM) presents a significant diagnostic challenge, contributing to substantial morbidity and mortality in endemic areas.
- Eosinophilic pleocytosis (EP) is a rare cerebrospinal fluid finding associated with a limited differential diagnosis.
Purpose of the Study:
- To investigate the frequency of eosinophilic pleocytosis in patients diagnosed with coccidioidal meningitis.
- To determine the prognostic significance of eosinophilic pleocytosis in the context of CM.
Main Methods:
- A retrospective chart review was conducted for all patients diagnosed with CM between 1986 and 1991.
- Inclusion criteria required confirmed clinical and cerebrospinal fluid (CSF) findings indicative of CM.
Main Results:
- Eosinophilic pleocytosis was observed in 70% of the studied CM patients.
- Of those with EP, 30% met criteria for eosinophilic meningitis (≥10 eosinophils/mm³).
- No correlation was found between EP and patient demographics, serological tests, peripheral eosinophilia, or clinical outcomes.
Conclusions:
- Eosinophilic pleocytosis is a frequent finding in coccidioidal meningitis.
- While not a prognostic indicator, the presence of EP is diagnostically significant and warrants consideration for CM.