Central nervous system coccidioides immitis infections

Abstract

Coccidioidal meningitis occurs in healthy individuals and patients with AIDS or other immunosuppressive illnesses. The central nervous system infection results when Coccidioides immitis disseminates from a primary lung infection via a fungemia to reach the meninges. Cases develop primarily in individuals living in or traveling to the Lower Sonoran Life Zone of Southwest United States. Most cases begin as subacute granulomatous meningitis with occasional patients developing brain abscesses. Diagnosis may be challenging because C. immitis is isolated from cerebrospinal fluid in less than 50% of patients. However, a cerebrospinal fluid complement fixation test for IgG antibody to C. immitis has high sensitivity and specificity. Currently, optimal treatment is unclear. Standard therapy has been with life-long oral fluconazole or intrathecal amphotericin B followed by prolonged oral fluconazole. Liposomal amphotericin B given intravenously seems promising as an initial treatment as it has much higher brain penetration, less nephrotoxicity, and less severe infusion-related adverse effects than conventional amphotericin B. However, current comparative studies for efficacy of liposomal amphotericin B in coccidioidal meningitis are lacking.

It only takes one to do many jobs: Amphotericin B as antifungal and immunomodulatory drug

“…AmB is also effective for other mycoses such as aspergillosis, candidiasis, histoplasmosis, blastomycosis, coccidioidomycosis, sporotrichosis, fusariosis, and phaeohyphomycosis in the cases of lack of response to azoles or echinocandins. (Ellis, 2002; Davis and Porter, 2005; Metcalf and Dockrell, 2007; Chandrasekar, 2008; Gomez-Lopez et al, 2008; Muhammed et al, 2011). Additionally, AmB has activity against parasites as Trypanosoma cruzi , Schistosoma mansoni , Echinococcus multilocularis , and Leishmania spp, being the second drug of choice for the treatment for visceral leishmaniasis when antimonials fail or cannot be used (Yardley and Croft, 1999; Reuter et al, 2003; Mone et al, 2010; Paila et al, 2010).…”