Coccidioidomycosis-Related Hydrocephalus: a case control study

Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the southwestern United States. Meningitis occurs in approximately 1% of cases and often results in hydrocephalus necessitating shunting and lifelong antifungal therapy. Prior studies lack comparison with contemporaneous controls. In this study, we compare radiographic, laboratory, and longitudinal shunt survival data until revision and reprogramming. The objective was to compare the 7-year outcomes between patients who underwent shunting with and without coccidioidomycosis meningitis (CM). We identified neurosurgical patients who underwent initial shunt placement for hydrocephalus over 7 years at the University of Arizona - Tucson. Demographics, shunt characteristics, failure rates, imaging findings, operative complications, revision etiology, reprogramming rates, and mortality were compared. Of 180 initial shunt placements, 19 (11.7%) had CM. No differences in revision rates, reprogramming rate, time to first revision, or mortality were observed with antisiphon use. CM patients had lower mean final shunt pressures (56.9 ± 24.1 mmH₂O in CM (95% CI, 45.3-68.5 mmH₂O) vs. 76.3 ± 40.2 mmH₂O in non-CM (95% CI, 70.3-83.3 mmH₂O), p = 0.04) at a mean follow-up of approximately 1.7 - 1.9 years. Two-year shunt survival was 65.5% in CM (95% CI, 38.4% - 82.9%) vs. 70.4% in Non-Coccidioidomycosis (non-CM) (95% CI, 60.9% - 78.0%) (p = 0.71); patient survival was 92.3% in CM (95% CI, 56.6% - 98.9%) vs. 89.5% in non-CM (95% CI, 82.1% - 93.8%) (p = 0.97). Anti-siphon valves were used in 78.9% of CM patients (95% CI, 54.4% - 93.9%) vs 74.5% of non-CM patients (95% CI, 67.1% - 81.1%) (p = 0.67). Despite similar valve types and revision etiologies, the data suggests CM-related hydrocephalus treatment requires lower shunt pressures over time and may indicate differences in intracranial compliance dynamics in CM patients.