393. Isavuconazole in the Treatment of Coccidioidal Meningitis
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Patients with coccidioidal meningitis require life-long antifungal therapy and cumulative toxicity from these agents may occur. Isavuconazole is the newest triazole antifungal and has demonstrated a lower toxicity profile than voriconazole and may represent a useful therapy in meningitis, although no data regarding efficacy in coccidioidal meningitis has yet been presented.

Methods: We conducted a retrospective analysis of all coccidioidal meningitis patients treated at our centers. Data abstracted included demographic and clinical information, results of laboratory and radiographic studies, serologic results, and outcomes. Responses to therapy were measured using a previously validated scoring system used in clinical trials of coccidioidal meningitis (MSG Coccidioidomycosis Scoring System).

Results: Nine patients met criteria for inclusion. Seven of nine were previously treated with voriconazole and transitioned to isavuconazole following: photodermatitis, 5 pts; transaminitis and photodermatitis 1 pt; failure of therapy, 1 pt. Two other patients failed fluconazole therapy and were transitioned to isavuconazole as salvage therapy. All patients transitioned to isavuconazole had a complete response to therapy 5 pts; or were deemed partial response (stable disease), 4 pts.

Conclusion: Isavuconazole therapy resulted in symptomatic and laboratory improvement in five of nine patients. The remaining patients exhibited clinical resolution of symptoms or continued with stable disease following adverse reactions to prior alternative triazole therapy. Isavuconazole may be a useful addition to the therapeutic choices currently available for coccidioidal meningitis.

Arash Heidari, M.D., Infectious Diseases, Kern Medical UCLA, Bakersfield, CA, Miriam Quinlan, MD, UCLA-Kern County, Bakersfield, CA, David Benjamin, MD, University of California, Davis, Davis, CA, Ian Mchardy, PhD, Medical Microbiology and Immunology, UC Davis, Davis, CA, Stuart H. Cohen, MD, FIDSA, FSHEA, FACP, Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, Royce H. Johnson, M.D., F.A.C.P., FIDSA, Infectious Diseases, Kern Medical Center/UCLA, Bakersfield, CA and George R. Thompson, MD, Medical Microbiology and Immunology, University of California, Davis, Davis, CA

Disclosures:

A. Heidari, None

M. Quinlan, None

I. Mchardy, None

S. H. Cohen, None

R. H. Johnson, None

G. R. Thompson, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.