Program Schedule

Patient Outcomes and Surgical Complications in Coccidioidal Meningitis: An Institutional Review

Session: Poster Abstract Session: CNS Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Coccidioides immitis infection is endemic to the southwestern U.S.   Chronic coccidioidal meningitis (CM) is frequently associated with multiple complications including hydrocephalus (HCP).  We describe the treatment and outcomes of surgical complications of CM.

Methods: Data from CM patients surgically treated in a single institution between 2005 and 2013 was retrospectively collected. Charts were reviewed to obtain clinical presentation, treatment, and outcomes.

Results: We identified 146 patients with CM.  Eighty-seven patients underwent a total of 177 neurosurgical procedures. The mean age was 44.3 years, male gender 72.4%.  Patients of Asian and African descent were overrepresented in the cohort when compared to regional demographics.  Comorbidities were present in 47.1%, and prior history of pulmonary coccidioides infection in 43.7%.  Presenting symptoms included:  headaches, encephalopathy, fever, ataxia, visual disturbances, nausea, and vomiting.  All patients received anti-fungal therapy, most frequently with an azole.  Twelve percent received concomitant intrathecal Amphotericin B.  HCP was present in 57.8%.  The most common surgical procedure was insertion of a ventriculoperitoneal (VP) shunt in 84% (n=73).  Other procedures included placement of Ommaya reservoirs and external ventricular devices.  The overall shunt failure rate was 50%; the average number of shunt revisions was 2.5 (range 1-8); eighty one percent were due to mechanical obstruction in the draining system.  Other complications included CNS device infection, stroke, and seizures.  CM was associated with high morbidity, requiring prolonged inpatient care in 25% of patients.

Conclusion: The majority of patients with CM developed complications requiring surgical intervention, most of which involved at least two surgeries.  Furthermore, a significant proportion required complex care.  We recommend a multidisciplinary approach, with early neurosurgical evaluation for the optimal management of CM.

Ana Moran, MD1, Wyatt Ramey2, Brian Beck, MD3, Yashar Kalani, MD, PhD4, Andrew Montoure5, Kris Smith6, Nicholas Theodore, MD4, Peter Nakaji, MD4 and Omar Gonzalez, MD7, (1)Infectious Diseases, Barrow Neurological Institute, Phoenix, AZ, (2)Barrow Neurological Institute, Phoneix, AZ, (3)Neurology, Barrow Neurological Institute, Phoenix, AZ, (4)Neurosurgery, Barrow Neurological Institute, St. Joseph Hospital, Phoenix, AZ, (5)Barrows Neurological Institute, Phoenix, AZ, (6)Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, (7)Arizona Pulmonary Specialists, Phoenix, AZ


A. Moran, None

W. Ramey, None

B. Beck, None

Y. Kalani, None

A. Montoure, None

K. Smith, None

N. Theodore, None

P. Nakaji, None

O. Gonzalez, None

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