Surgery for pulmonary coccidioidomycosis: a 10-year experience.
BACKGROUND
Coccidioidomycosis results from infection with Coccidioides species endemic to the southwestern United States. The mobile US population has resulted in incremental cases being found throughout the world. The fungal infection can result in pulmonary sequelae, including nodules, cavities, and complications requiring treatment by the thoracic surgeon.


METHODS
A retrospective chart review was conducted of 1,496 patients with coccidioidomycosis treated at our institution (January 1998 to December 2008) to identify those requiring surgery.


RESULTS
Of the 1,496 patients, 86 (6%; mean age, 58 years [range, 18 to 81], 48 women) underwent operations. Radiographs revealed 59 nodules, 18 cavities, 2 infiltrates, and 7 complications of disease (e.g., effusion, pneumothorax, and empyema). Of the 86 patients, 40% underwent resection for persistent symptoms or disease progression despite adequate antifungal therapy. One third of the operations were performed by video-assisted thoracoscopic surgery. Morbidity, 21% (18 patients), and in-hospital mortality, 2% (2 patients), were greater after resection for cavitary lesions with resultant complications versus for nodular disease: 41% versus 12% (p < or = 0.002) and 8% versus 0% (p < 0.005). Prolonged air leaks or bronchopleural fistulas were the most common complications (13 patients). Postoperative antifungal therapy was administered to 42% of patients (89% of cavitary and complicated). There were no cases of recurrence at follow-up (mean, 24 months).


CONCLUSIONS
Surgical intervention was indicated for only a few patients, most commonly for diagnostic dilemmas involving nodular disease, symptomatic nonresponsive cavitary disease, or complications. Prolonged air leaks were the main cause of morbidity. Resection should result in symptom resolution and long-term freedom from recurrence.
Jaroszewski
Dawn E
DE
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic, Scottsdale, Arizona, USA. jaroszewski.dawn@mayo.edu
Halabi
Wissam J
WJ
Blair
Janis E
JE
Coakley
Brandon J
BJ
Wong
Raymond K
RK
Parish
James M
JM
Vaszar
Laszlo T
LT
Kusne
Shimon
S
Vikram
Holenarasipur R
HR
DeValeria
Paterick A
PA
Lanza
Louis A
LA
Arabia
Francisco A
FA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003047:Coccidioidomycosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult