viernes, 23 de mayo de 2014

Characteristics of Patients with Mild to Moderate Primary Pulmonary Coccidioidomycosis - Volume 20, Number 6—June 2014 - Emerging Infectious Disease journal - CDC

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Characteristics of Patients with Mild to Moderate Primary Pulmonary Coccidioidomycosis - Volume 20, Number 6—June 2014 - Emerging Infectious Disease journal - CDC

link to Volume 20, Number 6—June 2014

Volume 20, Number 6—June 2014


Characteristics of Patients with Mild to Moderate Primary Pulmonary Coccidioidomycosis

Janis E. BlairComments to Author , Yu-Hui H. Chang, Meng-Ru Cheng, Laszlo T. Vaszar, Holenarasipur R. Vikram, Robert Orenstein, Shimon Kusne, Stanford Ho, Maria T. Seville, and James M. Parish
Author affiliations: Mayo Clinic Hospital, Phoenix, Arizona, USA (J.E. Blair, H.R. Vikram, R. Orenstein, S. Kusne, M.T. Seville);Mayo Clinic, Scottsdale, Arizona, USA (Y.-H. H. Chang, M.-R. Cheng, L.T. Vaszar, J.M. Parish)Arizona State University, Tempe, Arizona, USA (S. Ho)


In Arizona, USA, primary pulmonary coccidioidomycosis accounts for 15%–29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate coccidioidomycosis during 2010–2012, we conducted a prospective 24-week study of patients with primary pulmonary coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.
Coccidioidomycosis is a fungal infection caused by fungi of the genus Coccidioides. This illness is endemic to the southwestern United States. An estimated 150,000 infections occur annually, ≈60% in Arizona (1). The incidence of infection in this coccidioidomycosis-endemic area has considerably increased from 5.3 cases per 100,000 population in 1998 to 42.6 cases per 100,000 population in 2011 (2). Every year, ≈3% of area inhabitants become infected (3) through inhalation of airborne arthroconidia (spores), which results in mild to severe febrile respiratory illness (4,5). Extrapulmonary infection occurs in 1%–5% of patients with symptomatic infections (5,6).
Among Arizona patients with community-acquired pneumonia, 15%–29% have primary pulmonary coccidioidomycosis (79). Differentiating coccidioidal infection from pneumonia caused by viruses or bacteria is difficult. However, unlike other causes of community-acquired pneumonia, coccidioidomycosis is characterized by slow resolution of symptoms and extreme fatigue (10,11).
Symptomatic primary pulmonary coccidioidomycosis can range from mild to severe. Severe coccidioidomycosis has been defined as infection requiring hospitalization (1214). Little research has focused on milder symptomatic forms. Although mild to moderate infection has not been clearly defined, it is characterized by symptomatic illness that does not require patient hospitalization. In the study reported here, we sought to describe the clinical course of mild to moderate pulmonary coccidioidomycosis in patients who did or did not receive antifungal therapy.

Dr Blair is an infectious diseases consultant at Mayo Clinic, Scottsdale, Arizona, and a professor of medicine at Mayo Clinic College of Medicine. Her research interests include the study of coccidioidomycosis in immunosuppressed and healthy hosts.


  1. Sunenshine RHAnderson SErhart LVossbrink AKelly PCEngelthaler DPublic health surveillance for coccidioidomycosis in Arizona. Ann N Y Acad Sci2007;1111:96102 .Epub 2007 May 18DOIExternal Web Site IconPubMedExternal Web Site Icon
  2. Centers for Disease Control and PreventionIncrease in reported coccidioidomycosis: United States, 1998–2011. MMWR Morb Mortal Wkly Rep2013;62:21721 .PubMedExternal Web Site Icon
  3. Dodge RRLebowitz MDBarbee RBurrows BEstimates of C. immitis infection by skin test reactivity in an endemic community. Am J Public Health1985;75:8635DOIExternal Web Site IconPubMedExternal Web Site Icon
  4. Crum NFLederman ERStafford CMParrish JSWallace MRCoccidioidomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies. Medicine (Baltimore)2004;83:14975DOIExternal Web Site IconPubMedExternal Web Site Icon
  5. Smith CEBeard RRWhiting EGRosenberger HGVarieties of coccidioidal infection in relation to the epidemiology and control of the diseases. Am J Public Health Nations Health1946;36:1394402DOIExternal Web Site IconPubMedExternal Web Site Icon
  6. Cox RAMagee DMCoccidioidomycosis: host response and vaccine development. Clin Microbiol Rev2004;17:80439DOIExternal Web Site IconPubMedExternal Web Site Icon
  7. Valdivia LNix DWright MLindberg EFagan TLieberman DCoccidioidomycosis as a common cause of community-acquired pneumonia. [Erratum in: Emerg Infect Dis. 2006;12:1307]Emerg Infect Dis2006;12:95862DOIExternal Web Site IconPubMedExternal Web Site Icon
  8. Kim MMBlair JECarey EJWu QSmilack JDCoccidioidal pneumonia, Phoenix, Arizona, USA, 2000–2004. Emerg Infect Dis2009;15:397401DOIExternal Web Site IconPubMedExternal Web Site Icon
  9. Chang DCAnderson SWannemuehler KEngelthaler DMErhart LSunenshine RH,Testing for coccidioidomycosis among patients with community-acquired pneumonia.Emerg Infect Dis2008;14:10539DOIExternal Web Site IconPubMedExternal Web Site Icon
  10. Muir Bowers JMourani JPAmpel NMFatigue in coccidioidomycosis: quantification and correlation with clinical, immunological, and nutritional factors. Med Mycol.2006;44:58590DOIExternal Web Site IconPubMedExternal Web Site Icon
  11. Ampel NMGiblin AMourani JPGalgiani JNFactors and outcomes associated with the decision to treat primary pulmonary coccidioidomycosis. Clin Infect Dis2009;48:1728DOIExternal Web Site IconPubMedExternal Web Site Icon
  12. Flaherman VJHector RRutherford GWEstimating severe coccidioidomycosis in California. Emerg Infect Dis2007;13:108790DOIExternal Web Site IconPubMedExternal Web Site Icon
  13. Rosenstein NEEmery KWWerner SBKao AJohnson RRogers DRisk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995–1996. Clin Infect Dis2001;32:70815DOIExternal Web Site IconPubMedExternal Web Site Icon
  14. Durry EPappagianis DWerner SBHutwagner LSun RKMaurer MCoccidioidomycosis in Tulare County, California, 1991: reemergence of an endemic disease. J Med Vet Mycol.1997;35:3216 . DOIExternal Web Site IconPubMedExternal Web Site Icon
  15. Galgiani JNCatanzaro ACloud GAJohnson RHWilliams PLMirels LFMycoses Study GroupComparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis: a randomized, double-blind trial. Ann Intern Med2000;133:67686 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  16. Catanzaro AGalgiani JNLevine BESharkey-Mathis PKFierer JStevens DANIAID Mycoses Study GroupFluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis. Am J Med1995;98:24956DOIExternal Web Site IconPubMedExternal Web Site Icon
  17. Segal BHHerbrecht RStevens DAOstrosky-Zeichner LSobel JViscoli CDefining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis2008;47:67483DOIExternal Web Site IconPubMedExternal Web Site Icon
  18. Krupp LBLaRocca NGMuir-Nash JSteinberg ADThe fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol.1989;46:11213DOIExternal Web Site IconPubMedExternal Web Site Icon
  19. Ware JE JrGandek BOverview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol1998;51:90312DOIExternal Web Site IconPubMedExternal Web Site Icon
  20. Dickson ECGifford MACoccidioides infection (coccidioidomycosis). II. The primary type of infection. Arch Intern Med1938;62:85371DOIExternal Web Site Icon
  21. Arizona Department of Health Services. Arizona: Valley fever report, December 2007[cited 2008 Aug 9]. Adobe PDF fileExternal Web Site Icon
  22. Kerrick SSLundergan LLGalgiani JNCoccidioidomycosis at a university health service.Am Rev Respir Dis1985;131:1002 .PubMedExternal Web Site Icon
  23. Galgiani JNAmpel NMBlair JECatanzaro AJohnson RHStevens DAInfectious Diseases Society of AmericaCoccidioidomycosis. Clin Infect Dis2005;41:121723 . DOIExternal Web Site IconPubMedExternal Web Site Icon
  24. Blair JECoakley BSantelli ACHentz JGWengenack NLSerologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts.Mycopathologia2006;162:31724DOIExternal Web Site IconPubMedExternal Web Site Icon
  25. Thompson GR IIILunetta JMJohnson SMTaylor SBays DCohen SHEarly treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis.Clin Infect Dis2011;53:e204DOIExternal Web Site IconPubMedExternal Web Site Icon
  26. Blair JECurrier JTSignificance of isolated positive IgM serologic results by enzyme immunoassay for coccidioidomycosis. Mycopathologia2008;166:7782DOIExternal Web Site IconPubMedExternal Web Site Icon
  27. Blair JEMendoza NForce SChang YHGrys TEClinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance. Clin Vaccine Immunol2013;20:958 . Epub 2012 Nov 15DOIExternal Web Site IconPubMedExternal Web Site Icon
  28. United States Census Bureau. State & county quickfacts. Maricopa County, Arizona [revised 2014 Jan 6; cited 2014 Jan 20]. Web Site Icon
  29. Tsang CAAnderson SMImholte SBErhart LMChen SPark BJEnhanced surveillance of coccidioidomycosis, Arizona, USA, 2007–2008. Emerg Infect Dis2010;16:173844DOIExternal Web Site IconPubMedExternal Web Site Icon
  30. Ruddy BEMayer APKo MGLabonte HRBorovansky JABoroff ESCoccidioidomycosis in African Americans. Mayo Clin Proc2011;86:639DOIExternal Web Site IconPubMedExternal Web Site Icon



Suggested citation for this article: Blair JE, Chang YHH, Cheng MR, Vaszar LT, Vikram HR, Orenstein R, et al. Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis. Emerg Infect Dis [Internet]. 2014 Jun [date cited]. Web Site Icon
DOI: 10.3201/eid2006.131842

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