Coccidioidal meningitis

A marked improvement is generally noted after 4—8 weeks of treatment. Treatment is often continued until a total dose of 3 g is reached. In the case of coccidioidomycosis, for example, treatment with 0.4—0.8 mg/kg/d may last months. The polyene is adrninistered intrathecaHy to treat Coccidioides meningitis. However, the results are only moderate. It is very important to check renal and hepatic function during treatment with amphotericin B. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

Amphotericin B has been used intrathecally in patients with coccidioidal or cryptococcal meningitis. The side effects associated with this route of administration are headache, paraesthesia, nerve palsy, and visual impairment. To treat coccidioidal arthritis, amphotericin B may be injected intraarticularly (Figure 45.2). 

Coccidioides immitis is a dimorphic fungus that grows in soil in much of the southwestern United States infection results from inhalation of airborne C. immitis arthroconidia. Coccidioidomycosis is not transmitted from person to person. Approximately 60% of infected persons are asymptomatic the remainder can develop a spectrum of disease from mild influenza-like illness to pneumonia to disseminated disease, including meningitis. Because the incubation period for this infection ranges from 1 to 4 weeks, persons who may... 

Tucker RM, Williams PL, Arathoon EG, Levine BE, Hartstein Al, Hanson LH, Stevens DA. Pharmacokinetics of fluconazole in cerebrospinal fluid and serum in human coccidioidal meningitis. Antimicrob Agents Chemother 1988 32(3) 369-73. 

Coccidioidomycosis is caused by Coccidioides immitis and is endemic in some parts of the southwestern United States. It may cause nonspecific symptoms, acute pneumonia, or chronic pulmonary or disseminated disease. Primary pulmonary disease (unless severe) frequently is not treated, whereas extrapulmonary disease is treated with amphotericin B, and meningitis is treated with fluconazole. 

Fluconazole is the drug of choice for treatment of coccidioidal meningitis because of much less morbidity than with intrathecal amphotericin B. In other forms of coccidioidomycosis, fluconazole is comparable to itraconazole. Fluconazole has activity against histoplasmosis, blastomycosis, sporotrichosis, and ringworm, but response is less than with equivalent doses of itraconazole. Fluconazole is not effective in the prevention or treatment of aspergillosis. As with other azoles, with the possible exception of posa-conazole, there is no activity in mucormycosis. 

Intrathecal infusion of amphotericin B (C-AMB) is used in patients with meningitis caused by Coccidioides. Treatment is initiated with 0.05-0.1 mg and increased on a three-times-weekly schedule to 0.5 mg, as tolerated. Therapy is then continued on a twice-weekly schedule. 

Fluconazole is the drug of choice for coccidioidal meningitis and is comparable to itraconazole for other forms of coccidioidomycosis. Fluconazole is less active than itraconazole against... 

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