Coccidioidal Meningitis: Report of Four Cases With Necropsy Findings in Three Cases

SINCE Wernicke's original description in 1892 of the disease coccidioido-mycosis,111 ' lb knowledge of its natural history has been greatly expanded. A complete review of this information is beyond the scope of this report; however, certain important facts may be summarized as follows: It was not until 1937 that Gifford and Dixon 2,3»4 established the rela-tionship of the benign disease known as "valley fever " or "desert rheuma-tism " to the serious infection known as coccidioidal granuloma. Both were caused by the organism Coccidioides immitis. The endemic areas of in-fection in the United States 5 were well recognized prior to 1941. The signs and symptoms of primary coccidioidal infection are variable. Sixty per cent of the cases are asymptomatic. Forty per cent develop symp-toms resembling a severe cold or mild pneumonia within a period of one to three weeks after exposure.13 The primary infection may be complicated by erythema nodosum and polyarthritis in from 4 per cent to 25 per cent of the cases. This is associated with a hypersensitive state which is thought