Coccidioidal meningitis (CM) is a life-threatening infection with limited treatment options. Small series have reported success with isavuconazole; however, limited data exist on cerebrospinal fluid (CSF) penetration. Paired plasma and CSF isavuconazole concentrations were measured. Eleven CSF levels were tested, (7 ventricular, 4 lumbar) in three CM patients. Ventricular CSF levels were undetectable despite detectable plasma levels. All lumbar CSF levels were detectable (mean 1.00 µg/ml). Three pairs of lumbar CSF/plasma concentrations taken within 1 h of each other yielded a mean CSF/plasma ratio of 0.31. Isavuconazole was detectable in lumbar but not ventricular CSF in three patients treated for refractory CM. Lay Summary Isavuconazole is a triazole antifungal that has been used as salvage therapy in the treatment of coccidioidal meningitis (CM). Few data exist characterizing its concentration in the cerebrospinal fluid (CSF). We report tandem plasma and CSF concentrations of isavuconazole in three patients with CM.

中文翻译：

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艾沙康唑治疗难治性球虫性脑膜炎，同时进行脑脊液和血浆治疗药物监测

球孢子脑膜炎 (CM) 是一种危及生命的感染，治疗选择有限。小编报道了艾沙康唑成功；然而，关于脑脊液 (CSF) 渗透的数据有限。测量配对的血浆和脑脊液艾沙康唑浓度。在 3 名 CM 患者中测试了 11 个 CSF 水平（7 个脑室，4 个腰椎）。尽管可检测到血浆水平，但无法检测到脑室 CSF 水平。可检测到所有腰椎 CSF 水平（平均 1.00 µg/ml）。在 1 小时内采集的三对腰椎 CSF/血浆浓度的平均 CSF/血浆比率为 0.31。在三名接受难治性 CM 治疗的患者中，可在腰椎中检测到艾沙康唑，但在脑室 CSF 中未检测到。总结 艾沙康唑是一种三唑类抗真菌药，已被用作治疗球虫性脑膜炎 (CM) 的抢救疗法。很少有数据可以描述其在脑脊液 (CSF) 中的浓度。我们报告了三名 CM 患者中艾沙康唑的串联血浆和脑脊液浓度。