Coccidioidal meningitis. Intrathecal treatment with hyperbaric amphotericin B.
The localization of coccidioidal meningitis in the basilar regions, with resultant hydrocephalus and uniformly fatal outcome, has necessitated intrathecal injection of amphotericin B via cisternal puncture or subcutaneous ventricular reservoir for successful therapy. A simpler form of treatment is described here, whereby amphotericin B diluted in 10 percent glucose solution is injected via lumbar puncture, and delivered to the base of the skull by tilting the patient to a head-down position. A simultaneously performed hyperbaric cisternogram with (131)I-serum albumin has demonstrated satisfactory migration of the injected bolus to the occiput. This method of administration resulted in successful suppressive treatment of one patient, including two years of follow-up without serious sequelae or relapse.
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D003047:Coccidioidomycosis / Q000188:drug therapy*; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008581:Meningitis / Q000188:drug therapy*; D008722:Methods
D000666:Amphotericin B