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

Volume 20, Number 6—June 2014

Research

Characteristics of Patients with Mild to Moderate Primary Pulmonary Coccidioidomycosis

Article Contents

• Methods
• Results
• Discussion
• References
• Figure 1
• Figure 2
• Table 1
• Table 2
• Table 3
• Suggested Citation

Janis E. Blair , 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)

Suggested citation for this article

Abstract

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 (7–9). 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 (12–14). 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.

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Figures

• Figure 1. Coccidioidomycosis patient enrollment and exclusions, Arizona, USA, March 1, 2010–October 31, 2012.
• Figure 2. Presence of coccidioidomycosis symptoms from time of symptom onset, by treatment group, Arizona, USA, March 1, 2010–October 31, 2012The graphs represent the percentages of patients who reported each symptom,...

Tables

• Table 1. Characteristics of 36 patients with primary pulmonary coccidioidomycosis, Arizona, USA, March 1, 2010–October 31, 2012
• Table 2. Comparison of onset of symptoms to time to study end points among 36 patients with primary pulmonary coccidioidomycosis, Arizona, USA, March 1, 2010– October 31, 2012
• Table 3. Signs and symptoms since onset of coccidioidal Illness, among 36 patients with primary pulmonary coccidioidomycosis, Arizona, USA, March 1, 2010–October 31, 2012

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].http://dx.doi.org/10.3201/eid2006.131842

DOI: 10.3201/eid2006.131842