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Coccidioidal Meningitis

  • Peter C. Kelly
Part of the Current Topics in Infectious Disease book series (CTID)

Abstract

Coccidioidal meningitis (CM) is a lethal, chronic granulomatous disease of the leptomeninges caused by Coccidioides immitis. Untreated CM is uniformly fatal and accounts for the majority of the deaths caused by coccidioidomycosis.1,2,3 However, aggressive treatment with amphotericin B (AMB) reduces mortality and prolongs survival. This chapter will review our current concepts of CM, its diagnosis, and its treatment.

Keywords

Ommaya Reservoir Lateral Cerebral Ventricle Endemic Zone Symposium Specialist Fungal Meningitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    W. C. Buss, T. E. Gibson, and M. A. Gifford, Coccidioidomycosis of the meninges, Calif. Med. 72: 167–169 (1950).PubMedGoogle Scholar
  2. 2.
    R. W. Huntington, Jr., Morphology and racial distribution of fatal coccidioidomycosis, J. Am. Med. Assoc. 169: 115–118 (1959).PubMedCrossRefGoogle Scholar
  3. 3.
    R. W. Huntington, W. J. Waldmann, J A Sargent, H. O’Connell, R. Wybel, and D. Croll, Pathologic and clinical observations of 142 cases of fatal coccidioidomycosis with necropsy, in: Coccidioidomycosis ( L. Ajello, ed.), University of Arizona Press, Tucson (1967), pp. 143–167.Google Scholar
  4. 4.
    R. G. Caudill, C. E. Smith, J. A. Reinarz, Coccidioidal meningitis: A diagnostic challenge, Am. J. Med. 49: 360–365 (1970).PubMedCrossRefGoogle Scholar
  5. 5.
    D. Pappagianis and R. Crane, Survival in coccidioidal meningitis since introduction of amphotericin B, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 223–237.Google Scholar
  6. 6.
    W. A. Winn, The use of amphotericin B in the treatment of coccidioidal disease, Am. J. Med. 27: 617–635 (1959).PubMedCrossRefGoogle Scholar
  7. 7.
    E. C. Dickson and M. A. Gifford, Coccidioides infection (coccidioidomycosis). II. The primary type of infection, Arch. Intern. Med. 62: 853–871 (1938).CrossRefGoogle Scholar
  8. 8.
    E. C. Dickson, Coccidioidomycosis, J. Am. Med. Assoc. 111: 1362–1365 (1938).CrossRefGoogle Scholar
  9. 9.
    W. D. Forbus and A. M. Bestebreutje, Coccidioidomycosis: a study of 95 cases of the disseminated type with special reference to the pathogenesis of the disease, Mil. Surg. 99: 619–653 (1946).Google Scholar
  10. 10.
    K. H. Abbott and O. I. Cutler, Chronic coccidioidal meningitis, Arch. Pathol. 21: 320–330 (1936).Google Scholar
  11. 11.
    F. E. Jackson, D. Kent, and F. Clare, Quadriplegia caused by involvement of cervical spine with Coccidioides immitis, J. Neurosurg. 21: 512–515 (1964).PubMedCrossRefGoogle Scholar
  12. 12.
    S. D. Ingham, Coccidioidal granuloma of the spine with compression of the spinal cord, Bull. Los Angeles Neurol. Soc. 1: 41–49 (1936).Google Scholar
  13. 13.
    C. W. Rand, Coccidioidal granuloma, Arch. Neurol. Psychiatry 23: 502–511 (1930).CrossRefGoogle Scholar
  14. 14.
    M. L. Gottlieb, Coccidioidomycosis localized to the thoracic spinal cord and brain, with a plea for early diagnosis, Ariz. Med. 13: 131–139 (1956).PubMedGoogle Scholar
  15. 15.
    C. B. Courville and K. H. Abbott, Pathology of coccidioidal granuloma of the central nervous system and its envelopes, Bull. Los Angeles Neurol. Soc. 3: 27–41 (1938).Google Scholar
  16. 16.
    H. G. Schlumberger, A fatal case of cerebral coccidioidomycosis with cultural studies, Am. J. Med. Sci. 209: 483–496 (1945).CrossRefGoogle Scholar
  17. 17.
    A. E. Rhoden, Coccidioidal brain abscess, Bull. Los Angeles Neurol. Soc. 11: 80–85 (1946).PubMedGoogle Scholar
  18. 18.
    D. M. Goldstein and J. B. McDonald, Primary pulmonary coccidioidomycosis, J. Am. Med. Assoc. 124: 557–561 (1944).CrossRefGoogle Scholar
  19. 19.
    C. E. Smith, R. R. Beard, E. G. Whiting, and H. G. Rosenberger, Varieties of coccidioidal infection in relation to the epidemiology and control of the diseases, Am. J. Public Health 36: 1394–1402 (1946).CrossRefGoogle Scholar
  20. 20.
    C. E. Smith, M. T. Saito, R. R. Beard, R. M. Kepp, R. W. Clark, and B. U. Eddie, Serological tests in the diagnosis and prognosis of coccidioidomycosis, Am. J. Hyg. 52: 1–21 (1950).PubMedGoogle Scholar
  21. 21.
    P. C. Kelly, M. L. Sievers, R. Thompson, and C. Echols, Coccidioidal meningitis: results of treatment in 22 patients, in: Coccidioidomycosis, Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 239–251.Google Scholar
  22. 22.
    E. Rosen and J. P. Belber, Coccidioidal meningitis of long duration, Ann. Intern. Med. 34: 796–809 (1951).PubMedCrossRefGoogle Scholar
  23. 23.
    W. A. Winn, Coccidioidal meningitis: A follow-up report, in: Coccidioidomycosis ( L. Ajello, ed.), University of Arizona Press, Tucson (1967), pp. 55–62.Google Scholar
  24. 24.
    D. L. Reeves and C. F. Baisinger, Primary chronic coccidioidal meningitis: A diagnostic neurosurgical problem, J. Neurosurg. 2: 269–280 (1945).CrossRefGoogle Scholar
  25. 25.
    S. C. Deresinski and D. A. Stevens, Coccidioidomycosis in compromised hosts, Medicine 54: 377–395 (1974).CrossRefGoogle Scholar
  26. 26.
    N. Smithline, D. A. Ogden, A. I. Cohn, and K. Johnson, Disseminated coccidioidomycosis in renal transplant patients, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 201–208.Google Scholar
  27. 27.
    V. S. Rowland, R. E. Westfall, and W. A. Hinchcliffe, Fatal coccidioidomycosis: analysis of host factors, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 91–106.Google Scholar
  28. 28.
    H. Einstein, C. W. Holeman, Jr., L. Sandidge, and D. H. Holden, Coccidioidal meningitis, the use of amphotericin B in treatment, Calif. Med. 94: 339–343 (1961).PubMedGoogle Scholar
  29. 29.
    D. D. Norman and Z. R. Miller, Coccidioidomycosis of the central nervous system, a case of ten years’ duration, Neurology 4: 713–717 (1954).PubMedCrossRefGoogle Scholar
  30. 30.
    C. F. Sweigert, H. W. Turner, and J. B. Gillespie, Clinical and roentgenologic aspects of coccidioidomycosis, Am. J. Med. Sci. 212: 652–673 (1946).PubMedCrossRefGoogle Scholar
  31. 31.
    V. E. Jenkins and J. C. Postlewaite, Coccidioidal meningitis: report of four cases with necropsy findings in 3 cases, Ann. Intern. Med. 35: 1068–1084 (1951).PubMedCrossRefGoogle Scholar
  32. 32.
    F. Unterharnscheidt, M. DeBeukelaer, and J. L. Simon, Chronic untreated coccidioidomycosis of the central nervous system: a case of 7 1/2 years duration, Tex. Rep. Biol. Med. 27: 513–524 (1969).PubMedGoogle Scholar
  33. 33.
    W. A. Winn, The treatment of coccidioidal meningitis. The use of amphotericin B in a group of twenty-five patients, Calif. Med. 101: 78–89 (1964).PubMedGoogle Scholar
  34. 34.
    S. C. Deresinski, J N Galgiani, and D. A. Stevens, Miconazole treatment of human coccidioidomycosis: status report, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 267–294.Google Scholar
  35. 35.
    D. S. Zealear and W. A. Winn, The neurosurgical approach in the treatment of coccidioidal meningitis. Report of 10 cases, in: Coccidioidomycosis ( L. Ajello, ed.), University of Arizona Press, Tucson (1967), pp. 43–53.Google Scholar
  36. 36.
    D. Pappagianis, N. J. Lindsey, C. E. Smith, and M. T. Saito, Antibodies in human coccidioidomycosis: immunoelectrophoretic properties, Proc. Soc. Exp. Biol. Med. 118: 118–122 (1965).PubMedGoogle Scholar
  37. 37.
    Y. Sawaki, M. Huppert, J. W. Bailey, and Y. Yagi, Patterns of human antibody reactions in coccidioidomycosis, J. Bacteriol. 91: 422–427 (1966).PubMedGoogle Scholar
  38. 38.
    R. W. P. Cutler, G. V. Watters, J. P. Hammerstad, and E. Merler, Origin of cerebrospinal fluid gamma globulin in subacute sclerosing leukoencephalitis, Arch. Neurol. 17: 620–628 (1967).PubMedCrossRefGoogle Scholar
  39. 39.
    S. Cohen and R. Bannister, Immunoglobulin synthesis within the central nervous system in disseminated sclerosis, Lancet 1: 366–367 (1967).PubMedCrossRefGoogle Scholar
  40. 40.
    C. E. Smith, M. T. Saito, and S. A. Simons, Pattern of 39,500 serologic tests in coccidioidomycosis, J. Am. Med. Assoc. 160: 546–552 (1956).PubMedCrossRefGoogle Scholar
  41. 41.
    D. Pappagianis, M. Saito, and K. H. Van Hoosear, Antibody in cerebrospinal fluid in non-meningitic coccidioidomycosis, Sabouraudia 10: 173–179 (1972).PubMedCrossRefGoogle Scholar
  42. 42.
    E. A. Petersen, B. A. Friedman, E. D. Crowder, and D. Rifkind, Coccidioidouria: clinical significance, Ann. Intern. Med. 85: 34–38 (1976).PubMedCrossRefGoogle Scholar
  43. 43.
    M. J. Fiese, Coccidioidomycosis, p. 152, Charles C. Thomas, Springfield, Ill. (1958).Google Scholar
  44. 44.
    J. J. Ellner and J. E. Bennett, Chronic meningitis, Medicine 55: 341–370 (1976).PubMedCrossRefGoogle Scholar
  45. 45.
    W. A. Winn, Coccidioidomycosis, Med. Clin. North Am. 47: 1131–1148 (1963).PubMedGoogle Scholar
  46. 46.
    M. S. Collins and D. Pappagianis, Uniform susceptibility of various strains of Cocci dioides immitis to amphotericin B, Antimicrob. Agents Chemother. 11: 1049–1055 (1977).PubMedCrossRefGoogle Scholar
  47. 47.
    D. D. Bindschadler and J. E. Bennett, A pharmacologic guide to the clinical use of amphotericin B, J. Infect. Dis. 120: 427–436 (1969).PubMedCrossRefGoogle Scholar
  48. 48.
    C. W. Holeman and P. Johnson, Long term follow-up of amphotericin treated coccidioidal meningitis patients, Proceedings of the Twenty-First Annual Coccidioidomycosis Study Group, Abstract 1 (1976).Google Scholar
  49. 49.
    H. E. Einstein, Coccidioidomycosis of the central nervous system, in: Advances in Neurology, Vol. 6 ( R. A. Thompson and J. R. Green, eds.), Raven Press, New York (1974), pp. 101–106.Google Scholar
  50. 50.
    H. W. Buchsbaum, Clinical management of coccidioidal meningitis, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 191–200.Google Scholar
  51. 51.
    J. J. Castellot, F. W. Pitts, and F. H. Mowrey, A case of coccidioidal meningitis arrested by prolonged therapy with amphotericin B., Antibiot. Med. Clin. Ther. 6: 480–485 (1959).Google Scholar
  52. 52.
    N. P. Alazraki, J. Fierer, S. E. Halpern, and R. W. Becker, Use of a hyperbaric solution for administration of intrathecal amphotericin B, N. Engl. J. Med. 290: 641–646 (1974).PubMedCrossRefGoogle Scholar
  53. 53.
    K. P. Glynn, N. P. Alazraki, and T. A. Waltz, Coccidioidal meningitis-intrathecal treatment with hyperbaric Amphotericin B., Calif. Med. 119: 6–9 (1973).PubMedGoogle Scholar
  54. 54.
    M. LeClerc and S. T. Giammona, Coccidioidal meningitis, the use of amphotericin B intravenously and intrathecally by repeated lumbar punctures, West. J. Med. 122: 251–254 (1975).PubMedGoogle Scholar
  55. 55.
    J. P. Sung and J. G. Grendahl, Clinical experimental therapy with miconazole for human disseminated coccidioidomycosis, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 293–310.Google Scholar
  56. 56.
    J. R. Keane, Cisternal puncture complications-treatment of coccidioidal meningitis with amphotericin B, Calif. Med. 119: 10–15 (1973).PubMedGoogle Scholar
  57. 57.
    A. Underman, Private communication of a paper delivered at the Third International Coccidioidomycosis Symposium, Tucson (1976).Google Scholar
  58. 58.
    D. L. Kelly, Lateral cervical puncture for myelography, J. Neurosurg. 29: 106–110 (1968).PubMedCrossRefGoogle Scholar
  59. 59.
    R. A. Ratcheson and A. K. Ommaya, Experience with subcutaneous cerebrospinal-fluid reservoir, preliminary report of 60 cases, N. Engl. J. Med. 279: 1025–1031 (1968).PubMedCrossRefGoogle Scholar
  60. 60.
    R. D. Diamond and J. E. Bennett, A subcutaneous reservoir for intrathecal therapy of fungal meningitis, N. Engl. J. Med. 288: 186–188 (1973).PubMedCrossRefGoogle Scholar
  61. 61.
    A. J. Atkinson, Jr., and D. D. Bindschadler, Parmacokinetics of intrathecally administered amphotericin B, Am. Rev. Resp. Dis. 99: 917–924 (1969).PubMedGoogle Scholar
  62. 62.
    E. Goldstein, M. J. Winship, and D. Pappagianis, Ventricular fluid and the management of coccidioidal meningitis, Ann. Intern. Med. 77: 243–246 (1972).PubMedCrossRefGoogle Scholar
  63. 63.
    J. P. Utz, J. E. Bennett, M. W. Brandriss, W. T. Butler, and G.J. Hill II, Amphotericin B toxicity, Ann. Intern. Med. 61: 334–354 (1964).CrossRefGoogle Scholar
  64. 64.
    N. T. Carnevale, J. N. Galgiani, J. W. Langston, and D. A. Stevens, Myelopathy due to intrathecal amphotericin B, in: Coccidioidomycosis: Current Clinical and Diagnostic Status ( L. Ajello, ed.), Symposia Specialists, Miami (1977), pp. 259–260.Google Scholar
  65. 65.
    N. T. Carnevale, J. N. Galgiani, J. W. Langston, D. A. Stevens, and M. K. Herrick, Amphotericin-induced myelopathy, Neurology 27: 359 (1977).CrossRefGoogle Scholar
  66. 66.
    H. B. Levine, D. A. Stevens, J. M. Cobb, and A. E. Gebhart, Miconazole in coccidioidomycosis. I. Assay of activity in mice andin vitro, J. Infect. Dis. 132: 407–414 (1975).PubMedCrossRefGoogle Scholar
  67. 67.
    D. A. Stevens, H. B. Levine, and S. C. Deresinski, Miconazole in coccidioidomycosis. II. Therapeutic and pharmacologic studies in man, Am. J. Med. 60: 191–202 (1976).PubMedCrossRefGoogle Scholar
  68. 68.
    S. C. Deresinski, R. B. Lilly, H. B. Levine, J. N. Galgiani, and D. A. Stevens, Treatment of fungal meningitis with miconazole, Arch. Intern. Med. 137: 1180–1185 (1977).PubMedCrossRefGoogle Scholar
  69. 69.
    D. A. Stevens, Miconazole in the treatment of systemic fungal infections, Am. Rev. Resp. Dis. 116: 801–806 (1977).PubMedGoogle Scholar
  70. 70.
    S. H. Cheu and W. J. Waldmann, Unusual complications of ventriculo-atriostomy for communicating hydrocephalus in coccidioidal meningitis, in: Coccidioidomycosis ( L. Ajello, ed.), University of Arizona Press, Tucson (1967), pp. 25–30.Google Scholar

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© Springer Science+Business Media New York 1980

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  • Peter C. Kelly

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