Dis&Dat

Today we had rare case in the operating room. A patient, 28-year-old male, had meningitis. His symptoms included headache, sickness, not able to speak, hand spasm. He was diagnosed as coccidiomycosis meningitis. Meningitis is the infection of the membrane surrounding the brain and spinal cord. The nuerosurgeon preformed ventriculostomy on him. A CSF culture was sent to determine if there were other pathogens caused infection in his brain.

    Coccidiomycosis is also called Valley fever. It is an infection caused by the spores of  fungus, Coccidioides immitis. As the second most common fungal infection in America, it occurs almost exclusively in the desert areas of southwestern part of the country, which is where we live. The spores become airborne in the dry air, inhaled by human being and animals. No vaccine is invented to prevent it.

Among the population infected by the spores, about 60% of the infections cause no physical or respiratory signs, only recogenized by a coccidioidin skin test later on. The typical case is the body’s immune system clears out the infections and not to spread to organs.  The other 40% of the infections cause symptoms from mild to severe. While as a fungus, coccidioidin can cause serious harm for people whose immune system is weekend. Immunosuppressants and diseases such as AIDS weaken the immunes system. Antibiotics kill the normal flora of bacteria in the body, allowing fungi growth.

Drugs used to treat coccidiomycosis are amphotericin B, ketoconazole, fluconazole, or itraconazole. It is blieved that amphotericin B bind with membrane sterols and form hydrogen bonds among hydroxyl, carboxyl, and amino groups. The reaction produces aggregation and forms transmembrane channel, from where fungal cytoplasmic content leak out.

Reference

1. Jawetz, Melnick & Adelberg's medical microbiology, By George F. Brooks, Karen C. Carroll, M.D., Ernest Jawetz, Janet S. Butel, Stephen A. Morse, Edition: 24, McGraw-Hill Professional, 2007,ISBN 0071476660, 9780071476669

2. Overview of Coccidiomycosis,   http://www.myelectronicmd.com/get_reference.php?Id=1322&typ=

3.   http://www.pacificlife.com/Channel/Health+Center/Health+and+Medical+News/Past+Articles/Coccidiomycosis+(Valley+Fever).htm

4. http://yourtotalhealth.ivillage.com/treating-coccidioidomycosis-meningitis.html

5. http://en.wikipedia.org/wiki/Amphotericin_B