Sivasubramanian Geetha, Kadakia Saurin, Kim Jani M, Pervaiz Sarah, Yan Yueqi, Libke Robert
Division of Infectious Disease, University of California, San Francisco, Fresno, California, USA.
Department of Internal Medicine, University of California, San Francisco, Fresno, California, USA.
Open Forum Infect Dis. 2023 May 2;10(6):ofad243. doi: 10.1093/ofid/ofad243. eCollection 2023 Jun.
Coccidioidal meningitis (CM) is the most severe form of disseminated coccidioidomycosis. Despite years of clinical experience, it remains a difficult condition to treat, often requiring surgical procedures, such as placement of a ventriculoperitoneal shunt, in addition to lifelong antifungal therapy.
We performed a retrospective analysis of patients with CM seen in a large referral center in Central Valley, California, from 2010 to 2020. Data pertinent to CM were collected and analyzed.
Among 133 patients with CM identified in the 10-year period, nonadherence to antifungal therapy was noted in 43% of patients. Of the 80 patients who underwent ventriculoperitoneal shunt placement for management of intracranial pressure, shunt failure requiring revision surgery occurred in 42 (52.5%). Rehospitalizations due to CM-related reasons occurred in 78 of 133 patients (59%). Twenty-three percent of patients (n = 29) died due to complications from CM, on an average 22 months after the diagnosis of CM. Encephalopathy at presentation was associated with a significantly higher risk of death.
Patients with CM in central California are predominantly rural agricultural workers with elevated levels of poverty and low health literacy and many barriers to care, leading to high rates of medication nonadherence and loss to follow-up outpatient care. Management challenges are frequent, such as failure of antifungal therapy, high rates of rehospitalization, and the need for repeated shunt revision surgeries. In addition to the development of curative new antifungal agents, understanding the barriers to patient adherence to care and antifungal therapy and identifying means to overcome such barriers are of paramount importance.
球孢子菌性脑膜炎（CM）是播散性球孢子菌病最严重的形式。尽管有多年的临床经验，但它仍是一种难以治疗的疾病，除了终身抗真菌治疗外，通常还需要进行手术，如置入脑室腹腔分流管。
我们对2010年至2020年在加利福尼亚中央谷地一家大型转诊中心就诊的CM患者进行了回顾性分析。收集并分析了与CM相关的数据。
在这10年中确诊的133例CM患者中，43%的患者存在抗真菌治疗依从性差的情况。在80例因颅内压管理而接受脑室腹腔分流管置入的患者中，42例（52.5%）出现分流失败，需要进行翻修手术。133例患者中有78例（59%）因CM相关原因再次住院。23%的患者（n = 29）死于CM并发症，平均在CM诊断后22个月。就诊时出现脑病与死亡风险显著升高相关。
加利福尼亚中部的CM患者主要是农村农业工人，贫困程度高、健康素养低且存在许多就医障碍，导致药物治疗依从性差和门诊随访失访率高。管理挑战频繁出现，如抗真菌治疗失败、再住院率高以及需要反复进行分流翻修手术。除了开发新的治愈性抗真菌药物外，了解患者坚持治疗和抗真菌治疗的障碍并确定克服这些障碍的方法至关重要。
