Shunt Treatment for Coccidioidomycosis-Related Hydrocephalus: A Single-Center Series

Morshed, Ramin A.; Lee, Anthony T; Egladyous, Andrew; Avalos, Lauro N.; Aghi, Manish K.; Theodosopoulos, Philip V.; McDermott, Michael W.; Hervey-Jumper, Shawn L.

doi:10.1016/j.wneu.2020.03.135

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Additionally, and in accordance with experience from other centres, 60% of the patient that had a ventriculoperitoneal shunt placed required a revision. 28,29 Disease surveillance in our state is encouraged to better understand the geographic distribution, impact and disease risk.…”

Section: Discussionmentioning

confidence: 99%

Coccidioidomycosis in Oklahoma: A retrospective case series

Scott,

Sassine,

Gordon

et al. 2024

Mycoses

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BackgroundCoccidioidomycosis is a systemic fungal disease endemic to arid regions of the Western Hemisphere. In the south‐western US, Coccidioides spp. may account for up to 20%–25% of all cases of community acquired pneumonia. Clinical manifestations vary widely, from asymptomatic infection to life‐threatening disease, especially in immunocompromised hosts.ObjectivesThe primary objective of the study was to characterise cases of coccidioidomycosis in an area of the United States not considered traditionally endemic for the disease.MethodsWe performed a single‐centre retrospective study of all cases of coccidioidomycosis from 1 January 2000 to 31 December 2020, in the University of Oklahoma Health Sciences Medical Center.ResultsA total of 26 patients were included for analysis. The central nervous system (CNS) and the lungs were the sites most frequently involved. Twenty (77%) had travelled to a coccidioidomycosis endemic region. Most were male (81%) with a median age of 42 years (range: 3–78 years). The majority (46%) were Caucasians, 19% were African American, 19% Hispanic, and 12% Native American. The most common comorbidities were diabetes mellitus and acquired immunodeficiency syndrome, identified in 27% and 23% of patients, respectively. Patients on immunosuppressive therapy accounted for 12% of all cases.ConclusionOur study is one of the largest single‐centre case series of coccidioidomycosis from a non‐endemic area. Diabetes mellitus was the most frequent comorbidity. Compared to other case series of coccidioidomycosis, our patient population had higher rates of immunosuppression and had both a higher rate of disseminated disease and overall mortality.

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Section: Discussionmentioning

confidence: 99%

Coccidioidomycosis in Oklahoma: A retrospective case series

Scott,

Sassine,

Gordon

et al. 2024

Mycoses

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“…9,10 The experts also agreed that shunt placement should not be delayed with concern that delays in shunting lead to worse patient outcomes. 8,11 However, published guidelines do not specify optimal timing for a shunt in the management of hydrocephalus with increased ICP for minimally symptomatic patients. Some studies question the necessity of shunt placement early in the disease process due to risks and complications associated with indwelling shunts.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 The experts also agreed that shunt placement should not be delayed with concern that delays in shunting lead to worse patient outcomes. 8 , 11 …”

Section: Discussionmentioning

confidence: 99%

“…Some studies question the necessity of shunt placement early in the disease process due to risks and complications associated with indwelling shunts. 11 VP shunt placement is a lifelong process associated with a high likelihood of shunt failure requiring revisions due to catheter obstruction, infection with catheter biofilm formation and abscess development, hemorrhage, and other postprocedural complications, such as seizures. 8 , 12 , 13 Continued ventriculomegaly despite a properly functioning shunt and 9% mortality rate in patients who receive VP shunting are additional considerations.…”

Section: Discussionmentioning

confidence: 99%

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Non-shunt Management of Communicating Hydrocephalus in an Immunocompetent Host With Disseminated Central Nervous System Coccidioidomycosis

Menghani

Takamatsu

Ibrahim

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Disseminated coccidioidomycosis is associated with significant morbidity and mortality. Involvement of the meninges is often fatal if untreated, typically requiring lifelong antifungal therapy and neurosurgical intervention. We present the case of a young male without any known immunocompromising conditions who opted exclusively for medical management of newly diagnosed coccidioidomycosis meningitis with communicating hydrocephalus and discuss the controversy associated with this approach. This case highlights the importance of shared decision-making between patient and clinician, even if the plan diverges from available guidelines. Furthermore, we discuss clinical considerations in approaching the close outpatient monitoring of patients with central nervous system coccidioidomycosis with hydrocephalus.

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“…Patients who underwent VP shunt placement for hydrocephalus required revision surgery, often multiple times (52%), likely contributing to the rehospitalization rates. While high rates of medication nonadherence was noted and may have contributed to shunt failures, previous studies in patients with CM have shown high rates of shunt failure even with adequate medical management [ 7 , 16 , 23 , 24 ]. Twenty-three percent of the patients died due to complications from CM, and we found that encephalopathy at presentation was associated with a significantly higher risk of death.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Long-term Management of Patients With Coccidioidal Meningitis: A Retrospective Analysis of Treatment and Outcomes

Sivasubramanian

Kadakia

Kim

et al. 2023

Open Forum Infectious Diseases

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Background Coccidioidal meningitis (CM) is the most severe form of disseminated coccidioidomycosis. Despite years of clinical experience, it remains a difficult condition to treat, often requiring surgical procedures, such as placement of a ventriculoperitoneal (VP) shunt in addition to lifelong anti-fungal therapy. Methods We performed a retrospective analysis of CM patients seen in a large referral center in Central Valley, California, from 2010–2020. Data pertinent to CM were collected and analyzed. Results Among 133 patients with CM identified in the 10-year period, non-adherence to antifungal therapy was noted in 43% of patients. Out of the eighty patients who underwent VP shunt placement for management of intracranial pressure, shunt failure requiring revision surgery occurred in forty-two (52.5%). Rehospitalizations due to CM related reasons occurred in 78/133 patients (59%). Twenty-three percent of patients (n=29) died due to complications from CM, on an average 22 months after the diagnosis of CM. Encephalopathy at presentation was associated with a significantly higher risk of death. Conclusions CM patients in Central California are predominantly rural agricultural workers with elevated levels of poverty and low health literacy with many barriers to care leading to high rates of medication non-adherence and are lost to follow-up outpatient care. Management challenges are frequent such as failure of antifungal therapy, high rates of rehospitalization, and the need for repeated shunt revision surgeries. In addition to the development of curative new anti-fungal agents, understanding the barriers to patient adherence to care and anti-fungal therapy and identifying means to overcome such barriers is of paramount importance.

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Shunt Treatment for Coccidioidomycosis-Related Hydrocephalus: A Single-Center Series

Cited by 6 publications

References 16 publications

Coccidioidomycosis in Oklahoma: A retrospective case series

Coccidioidomycosis in Oklahoma: A retrospective case series

Non-shunt Management of Communicating Hydrocephalus in an Immunocompetent Host With Disseminated Central Nervous System Coccidioidomycosis

Challenges in the Long-term Management of Patients With Coccidioidal Meningitis: A Retrospective Analysis of Treatment and Outcomes

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