title: The impact of early and brief corticosteroids on the clinical course of primary pulmonary coccidioidomycosis.
abstract: OBJECTIVE
  Primary pulmonary coccidioidomycosis can often be associated with hypersensitivity symptoms treatable with a short course of palliative corticosteroids. Long-term use of corticosteroids is a known risk factor for severe or disseminated infection but the effects of short-term use are not known.
  
  
  METHODS
  A retrospective review was conducted of immunocompetent patients with acute pulmonary coccidioidomycosis who received systemic corticosteroids for relief of coccidioidal-related symptoms. Age- and sex-matched controls were also reviewed. Predetermined end-points were assessed.
  
  
  RESULTS
  Seventy-four patients met inclusion criteria for the corticosteroid-treated group, and 74 controls were identified. Cumulative corticosteroid (prednisone-equivalent) doses were 10 mg → 3,600 mg (mean = 206 mg; median = 120 mg). Corticosteroids were prescribed most commonly for rash 43/74 [58%] or asthma/wheezing/cough 30/74 [41%]. Coccidioidal-related hospitalization occurred in 19 patients in the corticosteroid group vs. 22 in the control group (P = .58). Coccidioidal-related symptoms resolved within a mean of 19 weeks (median = 8 weeks [range = 2-208 weeks]) vs. 32.3 weeks (median = 8 weeks [range = 1-1040 weeks]) in the corticosteroid and control groups (P = .38). Relapse of symptoms occurred in 12% of both groups (P > .99). Extrapulmonary dissemination occurred in 3% vs. 4.0% (P > .99) in the corticosteroid and control groups, respectively.
  
  
  CONCLUSIONS
  This study found no adverse effects of short-term corticosteroid therapy for early symptomatic treatment in acute pulmonary coccidioidomycosis.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA. azadeh.natalya@mayo.edu
authors.forename: Natalya
authors.initials: N
authors.lastname: Azadeh
authors.forename: Yu-Hui H
authors.initials: YH
authors.lastname: Chang
authors.forename: Shimon
authors.initials: S
authors.lastname: Kusne
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
authors.forename: Maria T
authors.initials: MT
authors.lastname: Seville
authors.forename: Robert
authors.initials: R
authors.lastname: Orenstein
authors.forename: Janis E
authors.initials: JE
authors.lastname: Blair
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003047:Coccidioidomycosis / Q000188:drug therapy* / Q000473:pathology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents