title: Coccidioidomycosis in patients infected with human immunodeficiency virus: review of 91 cases at a single institution.
abstract: We retrospectively evaluated the clinical manifestations, diagnosis, treatment, and outcome of coccidioidomycosis in 91 patients infected with human immunodeficiency virus (HIV) at a single institution. Coccidioidomycosis was the AIDS-defining illness in 37 patients. Fever and chills, weight loss, and night sweats were the most frequent symptoms. The lung was the most frequently involved organ (80%), followed by the meninges (15%). A diffuse reticulonodular infiltrate was seen in 59 patients (65%), and 13 (14%) had focal pulmonary disease; for 15 patients (16%), the chest radiograph was normal. Coccidioidal serologies were positive for 60 patients (68%), while for 23% with proven coccidioidomycosis such tests were negative Most patients were treated with systemic amphotericin B and then an oral azole. The mortality for the whole group was 60%. Patients with diffuse pulmonary disease had the highest mortality (68%), with a median duration of survival of 54 days (P < .05; 95% confidence interval, 147-175 days). The presence of diffuse pulmonary disease and a CD4 lymphocyte count of < 50/microL were independent predictors of death. In our experience, coccidioidomycosis is an important opportunistic infection that causes substantial morbidity and mortality among HIV-infected patients living in an area of endemicity.
authors.affiliation: Maricopa Medical Center, Department of Internal Medicine, Phoenix, Arizona 85008, USA.
authors.forename: V R
authors.initials: VR
authors.lastname: Singh
authors.forename: D K
authors.initials: DK
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Lawerence
authors.forename: P C
authors.initials: PC
authors.lastname: Kelly
authors.forename: A R
authors.initials: AR
authors.lastname: Thomas
authors.forename: B
authors.initials: B
authors.lastname: Spitz
authors.forename: G A
authors.initials: GA
authors.lastname: Sarosi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents