New therapies needed for CNS coccidioidomycosis in children: study

A recent study has provided further evidence on the incidence of central nervous system (CNS) coccidioidomycosis, which is a rare and potentially dangerous complication of disseminated coccidioidomycosis. Many patients present with relatively low compliment fixation (CF) titer, and hydrocephalus often occurs.

In addition, failures in fluconazole treatment frequently happen. Despite recent advances in therapy, difficulty in management persists, according to the authors.

A retrospective case review was carried out involving 30 patients aged ≤21 years who were diagnosed with CNS coccidioidomycosis from 1 January 2000 to 31 December 2018.

Of the patients, 93 percent were previously healthy. The most common presenting clinical manifestation was fever (90 percent), followed by headache 70 percent), fatigue (57 percent), and vomiting (53 percent). Fourteen (47 percent) patients also presented with focal neurological signs/symptoms.

Thirty-three percent of patients had initial serum Coccidioides CF titer of ≤1:8. Most of them presented with extra-axial brain involvement (83 percent), while seven (23 percent) had related spinal cord disease. In addition, shunt placement and revision were required in 70 percent and 62 percent, respectively.

Twenty-two (73 percent) patients were initially treated with fluconazole, but half of them (50 percent) had treatment failure. Majority of the patients (77 percent) stabilized and continued suppressive therapy; four (13 percent) had a relapse or progressive disease and one (3 percent) died, while 17 percent experienced long-term neurological complications.

“Most patients do well once the disease is stabilized and require lifelong therapy,” said the authors. “Newer therapeutic agents are needed.”