A New Method for the Treatment of Chronic Fungal Meningitis: Continuous Infusion into the Cerebrospinal Fluid for Coccidioidal Meningitis

Berry, C.D.; Stevens, David A.; Hassid, Eric I.; Pappagianis, Demosthenes; Happs, Edie L.; Sahrakar, Kamran

doi:10.1097/maj.0b013e3181a3dac8

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Currently, intrathecal AmB is commonly utilized as rescue therapy in azole failures. It is usually given in centers with special expertise because of the toxicity associated with this form of therapy [134,135]. Therapy is often initiated with low doses that are gradually increased unless untoward symptoms and signs of toxicity are encountered.…”

Section: Evidence Summarymentioning

confidence: 99%

2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Galgiani

Ampel

Blair

et al. 2016

Clinical Infectious Diseases

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452

537

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It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

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Section: Evidence Summarymentioning

confidence: 99%

2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Galgiani

Ampel

Blair

et al. 2016

Clinical Infectious Diseases

Self Cite

452

537

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“…For example, a child with central nervous system lymphoma was failing intravenous retuximab, but when the retuximab was administered via an Ommaya catheter at lower concentrations, there was complete regression of the lymphoma [16]. Ommaya catheters have also been successfully used to deliver methotrexate for central nervous system lymphoma, isoniazid for tuberculous meningitis and amphotericin for coccidioidal meningitis [17][18][19]. In all of these applications, the aim was to get high concentrations in brain for maximum efficacy and minimum side effects outside the brain, exactly the scenario here.…”

Section: Presentation Of the Hypothesismentioning

confidence: 97%

Cerebroventricular clozapine would be a viable treatment modality for clozapine-dependent schizophrenia patients with neutropenia

Alisky

2012

Medical Hypotheses

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“…Hence, these injections should only be attempted by someone experienced in these procedures. Berry et al [41] have recently reported on the successful use of an intracisternal catheter attached to a programable pump that allowed continuous infusion of amphotericin B deoxycholate. Unfortunately, relapses once intrathecal therapy is discontinued are frequent and ultimate cure appears to be only about 30% [1].…”

Section: Treatmentmentioning

confidence: 99%

Central Nervous System Infections Due to Coccidioidomycosis

Jackson

Blair

Ampel

2019

JoF

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Coccidioidomycosis is a common infection in the western and southwestern United States as well as parts of Mexico and Central and South America and is due to the soil-dwelling fungi Coccidioides. Central nervous system (CNS) infection is an uncommon manifestation that is nearly always fatal if untreated. The presentation is subtle, commonly with headache and decreased mentation. The diagnosis should be considered in patients with these symptoms in association with a positive serum coccidioidal antibody test. The diagnosis can only be established by analysis of cerebrospinal fluid (CSF), which typically demonstrates a lymphocytic pleocytosis, hypoglycorrhachia, elevated protein, and positive CSF coccidioidal antibody. Cultures are infrequently positive but a proprietary coccidioidal antigen test has reasonable sensitivity. Current therapy usually begins with fluconazole at 800 mg daily but other triazole antifungals also have efficacy and are often used if fluconazole fails. Triazole therapy should be lifelong. Intrathecal amphotericin B, the original treatment, is now reserved for those in whom triazoles have failed. There are several distinct complications of CNS coccidioidal infection, the most common of which is hydrocephalus. This is nearly always communicating and requires mechanical shunting in addition to antifungal therapy. Other complications include cerebral vasculitis, brain abscess, and arachnoiditis. Management of these is difficult and not well established.

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A New Method for the Treatment of Chronic Fungal Meningitis: Continuous Infusion into the Cerebrospinal Fluid for Coccidioidal Meningitis

Cited by 10 publications

References 13 publications

2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Cerebroventricular clozapine would be a viable treatment modality for clozapine-dependent schizophrenia patients with neutropenia

Central Nervous System Infections Due to Coccidioidomycosis

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