Coccidioidal meningitis. Intrathecal treatment with hyperbaric amphotericin B

Area of Science:

• Neuroscience
• Infectious Diseases
• Pharmacology

Background:

• Coccidioidal meningitis often affects basilar regions, leading to hydrocephalus and a fatal outcome.
• Intrathecal amphotericin B administration via cisternal puncture or ventricular reservoir is typically required for successful therapy.

Purpose of the Study:

• To describe a simpler method for administering intrathecal amphotericin B for coccidioidal meningitis.
• To evaluate the efficacy and delivery of this simplified treatment approach.

Main Methods:

• Amphotericin B diluted in 10% glucose solution was injected via lumbar puncture.
• Patients were positioned head-down to facilitate drug delivery to the skull base.
• Hyperbaric cisternography with (131)I-serum albumin was used to track drug migration.

Main Results:

• The described lumbar puncture method successfully delivered the amphotericin B bolus to the occiput.
• One patient with coccidioidal meningitis received successful suppressive treatment.
• The patient experienced two years of follow-up without relapse or serious sequelae.

Conclusions:

• A simplified intrathecal amphotericin B administration via lumbar puncture and head-down positioning is a viable treatment for coccidioidal meningitis.
• This method offers a less invasive alternative to cisternal puncture or ventricular reservoirs.
• Further studies are warranted to confirm the efficacy and safety in a larger patient cohort.