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Coccidioidomycosis-related hydrocephalus: A case control study
Pravarakhya Puppalla1, Dara S Farhadi1, Derek Smetanick1
1Department of Neurosurgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona85724-5070, USA.
Medical Mycology
|July 25, 2026
Summary
Coccidioidomycosis meningitis (CM) patients with hydrocephalus required lower shunt pressures compared to non-CM patients, despite similar shunt survival and revision rates. This suggests unique intracranial compliance dynamics in CM cases.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Medical Mycology
Background:
- Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the southwestern U.S.
- Coccidioidomycosis meningitis (CM) occurs in ~1% of cases, often leading to hydrocephalus requiring shunting and long-term antifungal therapy.
- Previous studies on CM meningitis and hydrocephalus lacked contemporaneous control groups.
Purpose of the Study:
- To compare 7-year outcomes of hydrocephalus shunting in patients with and without Coccidioidomycosis meningitis (CM).
- To analyze radiographic, laboratory, and longitudinal shunt survival data, including revision and reprogramming rates.
- To investigate potential differences in intracranial compliance dynamics between CM and non-CM patients.
Main Methods:
- Retrospective analysis of neurosurgical patients undergoing initial shunt placement for hydrocephalus over 7 years.
- Comparison of demographics, shunt characteristics, failure rates, imaging findings, operative complications, revision etiology, reprogramming rates, and mortality between CM and non-CM groups.
- Evaluation of shunt survival and patient survival rates, with specific attention to the use of anti-siphon valves.
Main Results:
- Of 180 initial shunt placements, 19 (11.7%) had CM.
- No significant differences were observed in revision rates, reprogramming rates, time to first revision, or mortality between CM and non-CM patients.
- CM patients exhibited significantly lower mean final shunt pressures (56.9 mmH₂O vs. 76.3 mmH₂O; P = 0.04), suggesting altered intracranial compliance.
Conclusions:
- Hydrocephalus treatment in Coccidioidomycosis meningitis patients may necessitate lower shunt pressures over time.
- Similar shunt survival and revision rates indicate comparable hardware performance but highlight potential differences in cerebrospinal fluid dynamics.
- The findings suggest distinct intracranial compliance dynamics in CM patients, warranting further investigation into hydrocephalus management strategies.
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