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Posaconazole for chronic refractory coccidioidal meningitis
Rebecca Schein1, James Homans, Robert A Larsen
1Maternal Child and Adolescent Center for Infectious Diseases and Virology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. rschein@alumni.indiana.edu
Summary
Coccidioidal meningitis can be fatal, with fluconazole often failing. Posaconazole showed promise as an alternative treatment, improving symptoms and lab results in patients with chronic, treatment-resistant fungal meningitis.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Coccidioidal meningitis is a severe fungal infection of the central nervous system.
- Fluconazole resistance and treatment failure are significant challenges in managing this condition.
- Limited safe and effective alternative therapies exist for refractory cases.
Observation:
- Three patients with chronic, previously unresponsive coccidioidal meningitis were treated with posaconazole.
- Two patients experienced symptomatic and laboratory improvements.
- A third patient demonstrated clinical improvement.
Findings:
- Posaconazole therapy was associated with positive clinical outcomes in patients with treatment-resistant coccidioidal meningitis.
- The study suggests posaconazole may be a viable alternative for managing refractory cases.
- Improvements were observed in both clinical status and laboratory markers of infection.
Implications:
- Posaconazole represents a potential therapeutic option for patients with coccidioidal meningitis who fail standard treatments.
- Further research is warranted to establish optimal dosing and long-term efficacy of posaconazole in this patient population.
- This finding could lead to improved management strategies for this life-threatening fungal infection.
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