Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies.
Coccidioidomycosis is a fungal disease with protean manifestations endemic to the Lower Sonoran Life Zone, which includes the hot deserts of the southwestern United States and areas of Mexico. Two hundred and twenty-three patients were found to have coccidioidomycosis at our institution from 1994-2002, the largest reported cohort of coccidioidomycosis patients since the 1950s. Of these patients, 58% presented with isolated pulmonary disease, 14% had high (>1:16) complement fixation titers without clear evidence of dissemination, 22% had definite disseminated disease, and 5% had unclassified disease. Enzyme immunoassay was a reliable diagnostic tool in those with symptomatic disease, but had a low specificity in those who were asymptomatic. Complement fixation titers of > or =1:16 were associated with dissemination to bone or skin but were not helpful in evaluating central nervous system disease. Thirteen percent of patients with high complement fixation titers (>1:16) without clear evidence of dissemination on presentation and 7% of those with isolated pulmonary disease eventually progressed to disseminated disease; 30% of Filipino patients with pulmonary disease progressed to disseminated disease. Nonwhite race was a predictor for dissemination; African American patients more often developed disseminated bony disease while Filipinos were more likely to develop cutaneous or central nervous system disease. Relapse of disseminated coccidioidomycosis occurred in 24% of patients; the risk was highest (71%) among those with central nervous system disease. Azole therapy was generally inferior to amphotericin B in disseminated disease. Predictors of permanent disability included African American or Filipino race, central nervous system disease, and bony disease.
Crum
Nancy F
NF
From Infectious Disease Division, Naval Medical Center San Diego, San Diego, California.
Lederman
Edith R
ER
Stafford
Christopher M
CM
Parrish
J Scott
JS
Wallace
Mark R
MR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D021821:Communicable Diseases, Emerging / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D012189:Retrospective Studies; D012698:Serologic Tests
D000935:Antifungal Agents