Coccidioidal Meningitis: A Review on Diagnosis, Treatment, and Management of Complications

Abstract

Ho et al. described the preparation and administration of intrathecally delivered amphotericin B deoxycholate. Thompson et al. described possible benefits of controversial adjuvant corticosteroid therapy for secondary prevention of vasculitic infarction secondary to CM. CM was universally fatal until the advent of intrathecal amphotericin B deoxycholate therapy, the introduction of which changed the natural history of the disease in much the same way as penicillin changed the natural history of bacterial meningitis. Although there was still significant morbidity, survival rates drastically increased to approximately 70%. The introduction of azole therapy has decreased the side effects and burden of treatment but without a significant change in CM-related mortality and morbidity compared with the use of intrathecal amphotericin B deoxycholate therapy.

Patient With a 42-Year History of Coccidioidal Meningitis

“…1,9,10 Seventy percent of patients have treatment response and improve to varying degrees but are on lifelong therapy. 11 This patient is living symbiotically with Coccidioides .…”

“…He has been adherent to high-dose fluconazole therapy. Based on available data since 2005, despite serum fluconazole drug levels that were largely within accepted limits (Figure 5) as per current practice of his infectious disease physicians, 11 he still has persistent lymphocytic pleocytosis, elevated protein, reactive IgG immunodiffusion, and positive complement fixation titer. To our knowledge, he is the longest surviving patient with CNS coccidioidomycosis.…”

Host–Pathogen Interactions in Coccidioidomycosis: Prognostic Clues and Opportunities for Novel Therapies

“…78 Similarly, corticosteroids have been advocated as an adjunctive therapy during treatment of central nervous system complications of coccidioidal meningitis, including cranial neuropathy, arachnoiditis, vasculitic infarction, encephalitis, and the development of a syrinx, or to ameliorate symptoms. 20,79,80 Intrathecal corticosteroids are also given along with intrathecal injection of AmB deoxycholate to address the headache, fever, and vomiting of this treatment. 80,81…”

“…20,79,80 Intrathecal corticosteroids are also given along with intrathecal injection of AmB deoxycholate to address the headache, fever, and vomiting of this treatment. 80,81…”

A case report of Coccidioides posadasii meningoencephalitis in an immunocompetent host

“…Coccidioides species are dimorphic fungi within the Ascomycete division [1]. The two species that have been found to cause human disease are Coccidioides immitis and Coccidioides posadasii [2, 3]. C. immitis and C. posadasii are morphologically identical with no known phenotypic differences in pathogenicity.…”