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Risk factors and outcomes of culture‐proven acute Coccidioides spp. infection in San Diego, California, United States
Author(s) -
Jenks Jeffrey D.,
Reed Sharon L.,
Hoenigl Martin
Publication year - 2020
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.13074
Subject(s) - coccidioides , medicine , coccidioides immitis , risk factor , disease , retrospective cohort study , cohort , blood culture , immunology , dermatology , biology , antibiotics , microbiology and biotechnology
Summary Background Coccidioides spp. are dimorphic fungi endemic to parts of the United States, Mexico, Central and South America. Infection can cause a range of disease from self‐limited acute pneumonia to severe disseminated disease. Methods We performed a retrospective chart review of medical records of cases of culture‐proven acute coccidioidomycosis at the University of California San Diego between 1 April 2015 and 31 December 2019 and described the demographics, risk factors and outcomes of these cases. Results Over the study period, fifteen evaluable cases of culture‐proven acute coccidioidomycosis were identified. Of these, 87% (13/15) had traditional risk factors for coccidioidomycosis infection while two lacked known risk factors, including one patient with cirrhosis and one with chronic hepatitis C infection. Seven of fifteen (47%) had primary coccidioidomycosis of the lungs without dissemination and 7/15 (47%) disseminated disease. Of those with disseminated disease, 6/7 (86%) had either high‐risk ethnicity or blood type as their only risk factor. At 90 days, 11/15 (73%) were alive, 3/15 (20%) deceased and 1/15 (7%) lost to follow‐up. Of those not alive at 90 days, 1/3 (33%) had disseminated disease and 2/3 (67%) primary coccidioidomycosis, both on immunosuppressive therapy. Discussion Coccidioides spp. infection occurs in a variety of hosts with varying underlying risk factors, with the majority in our cohort overall and 86% with disseminated disease lacking traditional risk factors for invasive fungal infection other than ethnicity and/or blood phenotype. Clinicians should be aware of these non‐traditional risk factors in patients with coccidioidomycosis infection.