Coccidioidal meningitis: Update on epidemiology, clinical features, diagnosis, and management

Blair, Janis E.

doi:10.1007/s11908-009-0043-1

Cited by 51 publications

(30 citation statements)

References 40 publications

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“…Comprehensive reviews of the manifestations and treatment of coccidioidal meningitis have been published recently (167,168). Intravenous amphotericin B did not control this disease, so until the introduction of azole antifungal drugs, intrathecal amphotericin B was the only available treatment.…”

Section: Complicated Pulmonary Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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SUMMARY Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii . This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.

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Section: Complicated Pulmonary Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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“…Although most patients will recover without medical intervention, people with progressive or chronic disease and populations with various compromises of the immune system require antifungal therapy (2)(3)(4). The most severe consequence of coccidioidal infection is meningitis, which requires lifetime antifungal therapy (5,6).…”

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confidence: 99%

Efficacy of the Investigational Antifungal VT-1161 in Treating Naturally Occurring Coccidioidomycosis in Dogs

Shubitz

Roy²,

Trinh

et al. 2017

Antimicrob Agents Chemother

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Coccidioidomycosis can be a chronic, systemic fungal infection requiring long-term to lifetime medication. Thus, there is a need for improved antifungal agents with greater efficacy and reduced toxicity. VT-1161 has a low affinity for mammalian cytochromes and potently inhibits fungal CYP51 with proven efficacy in murine models of central nervous system (CNS) and respiratory coccidioidomycosis. Dogs experience coccidioidomycosis similar to humans and are a useful preclinical model for naturally occurring disease. Twenty-four client-owned dogs diagnosed with respiratory coccidioidomycosis based on radiography, serology, clinical signs, and clinicopathologic abnormalities were treated with a loading dose of VT-1161 for 14 days, followed by 46 days of a lower maintenance dose. Twelve dogs received a high dose (29 mg/kg loading, 6 mg/kg maintenance) and 12 received a low dose (10 mg/kg loading, 1.6 mg/kg maintenance). Response to treatment was assessed by calculating the reduction in disease scores at exit compared to disease scores at enrollment. Overall, 20 of 24 (83%) dogs had Ն50% reduction in enrollment disease scores at exit (P Ͻ 0.001), with no difference between the high-and low-dose groups (P ϭ 0.66). Time-weighted average plasma concentrations for the high-and low-dose groups were 39 Ϯ 5 g/ml and 19 Ϯ 2 g/ml, respectively. In this openlabel study, VT-1161 was efficacious for the treatment of respiratory coccidioidomycosis in naturally infected dogs. Combined with previously reported murine data, this finding supports the further development of VT-1161 for the treatment of coccidioidomycosis in humans.

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“…Children with meningitis may present with headaches, altered sensorium, vomiting, and/or focal neurologic deficits. 27–29 Fever is sometimes absent, and meningismus occurs in only 50% of patients. Hydrocephalus complicating basilar inflammation 27,30 occurs in most (83%–100%) children with coccidioidal meningitis.…”

Section: Coccidioidomycosis (Last Updated November 6 2013; Last Revimentioning

confidence: 99%

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Siberry

Abzug

Nachman

et al. 2013

Pediatric Infectious Disease Journal

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Coccidioidal meningitis: Update on epidemiology, clinical features, diagnosis, and management

Cited by 51 publications

References 40 publications

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Efficacy of the Investigational Antifungal VT-1161 in Treating Naturally Occurring Coccidioidomycosis in Dogs

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

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