{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:46:09Z","timestamp":1790934369233,"version":"4.1.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 AI 007502"],"award-info":[{"award-number":["T32 AI 007502"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cases of coccidioidomycosis are increasing dramatically in the United States. The utility of intrathecal (IT) amphotericin in treating coccidioidal meningitis (CM) in the era of azole therapy is unknown. We sought to understand how IT therapy is associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective chart review of adult patients with laboratory-proven CM seen at Stanford Healthcare by an infectious diseases physician from 2008 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty-seven patients met inclusion criteria. All patients received azole therapy. Twenty-seven of those patients (47.4%) additionally received IT amphotericin. Patients receiving IT therapy had a higher median initial cerebrospinal fluid white blood cell count at diagnosis (462.5 vs 188 cells\/\u03bcL, P = .05), higher rates of intravenous liposomal amphotericin use (88.9% vs 56.7%, P = .02) and corticosteroid use (51.9% vs 26.7%, P = .09), and higher median therapeutic switches per year (0.84 vs 0.44, P = .01). An unadjusted Kaplan-Meier curve demonstrated a 5-year mortality rate of 26.7% in the IT amphotericin group, compared to 6.7% in the nonreceiver group (P = .28). A Cox regression revealed that older age at diagnosis (hazard ratio [HR], 1.07 [95% confidence interval {CI}, 1.03\u20131.11]), receipt of IT amphotericin (HR, 13.9 [95% CI, 1.92\u2013100.48]), and corticosteroid use (HR, 8.3 [95% CI, 1.92\u201335.4]) were significantly associated with mortality, with a significant interaction between IT amphotericin and corticosteroids (interaction HR, 0.14 [95% CI, .02\u2013.97]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients who received IT amphotericin had higher mortality rates than those who did not, likely reflecting disease refractory to treatment. More therapies are needed for those who have disease progression on azole therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf675","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:00:45Z","timestamp":1762520445000},"source":"Crossref","is-referenced-by-count":3,"title":["Use of Intrathecal Amphotericin for Coccidioidal Meningitis"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8079-700X","authenticated-orcid":false,"given":"Rebecca Y","family":"Linfield","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine , Stanford, California ,","place":["USA"]},{"name":"Division of Infectious Diseases, David Geffen School of Medicine at UCLA , Los Angeles, California 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