Sunday, February 15, 2015

A series of patients with primary pulmonary coccidioidomycosis

In this series of patients seen at the Mayo Clinic in Arizona several points are noteworthy:

It accounts for 15%–29% of community-acquired pneumonia in Arizona.

Symptom and radiographic resolution is slow, a matter of weeks.

It has seen a dramatic increase in Arizona. From the article:

The incidence of infection in this coccidioidomycosis-endemic area has considerably increased from 5.3 cases per 100,000 population in 1998 to 42.6 cases per 100,000 population in 2011.

Treatment criteria are controversial. Again, from the article:

Although the Infectious Diseases Society of America treatment guidelines acknowledge differences of expert opinion regarding the need to treat primary coccidioidomycosis (23), the guidelines suggest identifying characteristics to facilitate diagnosis of moderate to severe infection in patients who might benefit from treatment (23). These guidelines recommend possible antifungal treatment for patients with symptoms lasting greater than 2 months, night sweats greater than 3 weeks, weight loss of greater than 10%, inability to work, serologic complement fixation titer greater than 1:16, bilateral infiltrates or involvement of at least one half of 1 lung, or prominent or persistent hilar adenopathy (23).

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