title: Biofilm on ventriculo-peritoneal shunt tubing as a cause of treatment failure in coccidioidal meningitis.
abstract: We describe a case of recurrent coccidioidal meningitis in which a fungal biofilm on the tip of ventriculo-peritoneal shunt tubing was likely responsible for a 4-year persistence of Coccidioides immitis, despite the patient's taking an adequate dosage of fluconazole. Fungal biofilms should be considered as a cause for treatment failure and fungal persistence, especially when artificial prostheses or indwelling catheters are present.
authors.affiliation: New Mexico VA Health Care System, Albuquerque, NM 87108, USA. LEDavis@UNM.edu
authors.forename: Larry E
authors.initials: LE
authors.lastname: Davis
authors.forename: Guy
authors.initials: G
authors.lastname: Cook
authors.forename: J William
authors.initials: JW
authors.lastname: Costerton
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D018441:Biofilms / Q000254:growth & development*; D003045:Coccidioides / Q000302:isolation & purification; D003047:Coccidioidomycosis / Q000188:drug therapy / Q000382:microbiology; D004866:Equipment Contamination; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy* / Q000382:microbiology*; D008875:Middle Aged; D017211:Treatment Failure; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole