Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis

Abstract

In Arizona, USA, primary pulmonary coccidioidomycosis accounts for 15%-29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate coccidioidomycosis during 2010-2012, we conducted a prospective 24-week study of patients with primary pulmonary coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.

Keywords: Coccidioides; acute pulmonary coccidioidomycosis; antifungal therapy; coccidioidomycosis; community-acquired pneumonia; fungi.

Figure 1

Coccidioidomycosis patient enrollment and exclusions, Arizona, USA, March 1, 2010–October 31, 2012.

Figure 2

Presence of coccidioidomycosis symptoms from time of symptom onset, by treatment group, Arizona, USA, March 1, 2010–October 31, 2012. The graphs represent the percentages of patients who reported each symptom, from the time since onset of symptomatic illness. Solid lines and filled circles indicate the nontreatment group, and dashed lines and open circles indicate the treatment group. The vertical line indicates time of symptom onset. The circles to the left of the vertical line indicate the presence of symptoms at any time, including before study enrollment.