title: Coccidioidomycosis in the acquired immunodeficiency syndrome.
abstract: Of 27 patients with the acquired immunodeficiency syndrome (AIDS) in Tucson, Arizona, 7 had concurrent coccidioidomycosis. Early manifestations of infection in 6 patients included diffuse nodular pulmonary infiltrates and Coccidioides immitis in many extrathoracic sites. By comparison, a retrospective review of the cases of 300 patients hospitalized with coccidioidal infection identified only 13 patients without AIDS who had the same extent of infection, and only 3 of these patients had no immunosuppressing conditions. Antibodies for coccidioidal antigens at serum dilutions as high as 1:2048 were detected in 5 of the 7 patients with AIDS. Six had temporary responses to amphotericin B treatment, taken both alone and combined with ketoconazole, but all died within 14 months of their diagnosis of coccidioidomycosis. Because annual rates of coccidioidal infection in the Tucson area are 4% or less, the rate of 27% that we calculated, based on 7 patients having the infection during 26 years of risk for AIDS, suggests frequent reactivation of the infection or enhanced susceptibility to endemic exposure in persons with AIDS.
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001130:Arizona; D003047:Coccidioidomycosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000666:Amphotericin B; D007654:Ketoconazole