Harrison H R, Galgiani J N, Reynolds A F, Sprunger L W, Friedman A D
Pediatr Infect Dis. 1983 May-Jun;2(3):216-21. doi: 10.1097/00006454-198305000-00009.
Coccidioidal meningitis is a fatal form of Coccidioides immitis infection. Amphotericin B (AMB) therapy has reduced mortality but is itself toxic, and experience with it in very young children is meager. We are treating six children for coccidioidal meningitis diagnosed at 19 to 74 months of age. All had acute hydrocephalus and ventriculitis. The first four patients were initially treated with AMB but were changed to imidazole therapy (miconazole and ketoconazole). In the last two patients therapy was begun with the imidazoles. Ommaya reservoirs for cisternal therapy have been of limited usefulness. AMB therapy has been limited by local and systemic toxicity and by failure in one case. All children have improved with 15 to 22 mg oral ketoconazole per kg per day and 3 to 5 mg intraventricular miconazole for instillation therapy, including those with noncommunicating hydrocephalus in whom the intraventricular drug does not reach the basilar cisterns. Peak concentrations of ketoconazole in ventricular fluid were 0.08 to 5.6 micrograms/ml. Shunt obstruction and bacterial superinfections have been the major causes of morbidity. Imidazole therapy of coccidioidal meningitis may be more effective than is AMB in young children, and it offers the advantages of fewer side effects and not requiring intrathecal or cisternal administration.
球孢子菌性脑膜炎是一种由粗球孢子菌感染引起的致命疾病。两性霉素B（AMB）治疗虽降低了死亡率，但该药本身具有毒性，且在幼儿中的应用经验较少。我们正在治疗6名年龄在19至74个月被诊断为球孢子菌性脑膜炎的儿童。所有患儿均患有急性脑积水和脑室炎。前4例患者最初接受AMB治疗，但后来改为咪唑类药物治疗（咪康唑和酮康唑）。后2例患者一开始就采用咪唑类药物治疗。用于脑池内治疗的Ommaya贮器作用有限。AMB治疗受到局部和全身毒性以及1例治疗失败的限制。所有患儿每日每千克口服22毫克酮康唑和脑室内注入3至5毫克咪康唑进行滴注治疗后病情均有改善，包括那些患有非交通性脑积水且脑室内药物无法到达脑基底池的患儿。脑室内液体中酮康唑的峰值浓度为0.08至5.6微克/毫升。分流梗阻和细菌二重感染是发病的主要原因。咪唑类药物治疗球孢子菌性脑膜炎在幼儿中可能比AMB更有效，且具有副作用较少以及无需鞘内或脑池内给药的优点。
