Coccidioidal meningitis.
Coccidioidal meningitis affects between 200 to 300 persons annually within the endemic area of the United States, with much larger numbers expected in epidemic years. Because this represents a chronic disease for survivors, several thousand patients may be under treatment at any given time. Epidemiology, background, and diagnosis are reviewed. Azole therapy has replaced intrathecal amphotericin B for induction and maintenance therapy for this disease, given its ease of administration and equivalent efficacy in controlling infection even at the cost of losing the opportunity for cure. Both itraconazole and fluconazole have demonstrated efficacy, but have not been compared in randomized human studies. One of the uses of intrathecal amphotericin B is as "add on" therapy in failing azole regimens without evidence of antagonism. Details of therapeutic approach are reviewed. Approach to diagnosis and management of the two principal potentially life threatening complications, hydrocephalus and vasculitis, is also discussed.
Williams
Paul L
PL
The Permanente Medical Group, 2651 Highland Avenue, Selma, CA 93662, USA. traildoc11@yahoo.com
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000628:therapy*; D015897:Comorbidity; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy; D017964:Itraconazole / Q000627:therapeutic use; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014657:Vasculitis / Q000628:therapy
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole