P278 Brain abscess caused by dematiaceous fungi in apparently immunocompetent hosts: Acase series

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVE: Dematiaceous or melanized fungi, can cause CNS involvement even in apparently immunocompetent hosts because of the intense neurotropism of the fungus. We present a series of 4 such cases. METHODS: Case series RESULTS: Figs. 1 and 2 CONCLUSION: The diagnosis of the disease is challenging due to its rarity, lack of specific signs and symptoms, and radiological findings of the disease. Radiologic reports should give a DD rather than name a specific condition. This prevents a biopsy procedure and leads to the use of empiric, ineffective, toxic, expensive therapy and disease progression. In our case series, the mean days to diagnosis from symptom onset was 49 days. Although, less than what is reported in the literature which is 115 days, it is still late to be of meaningful value to the patient. There are many factors like antifungal DST, interpretation of MIC when there is no BP available, cost of antifungal therapy, therapeutic drug monitoring, need for repeat surgery, active follow-up, and awareness among surgical colleagues remain a major concern in Indian settings. Combination of antifungal drugs for life long along with wide surgical resection with frequent follow-ups which includes TDM, radiological assessment, need for repeat surgery, and management of adverse drug reactions of antifungal drugs are the unmet clinical needs.