969. Intensive Study of Patients with Primary Pulmonary Coccidioidomycosis
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
  • Hoover IDSA 2011.pdf (4.0 MB)
  • Intensive Study of Patients with Primary Pulmonary Coccidioidomycosis Susan E. Hoover, MD, Suzette Chavez, BA, John N. Galgiani, MD and David E. Nix, PharmD Univ. of Arizona, Tucson, AZ, USA Background: Coccidioidomycosis (valley fever) is a fungal infection endemic to the American Southwest, but seen all over the country and the world due to travel and migration. Early infection is often unrecognized by the patient and/or clinician. We had the opportunity to investigate the early manifestations and clinical course as part of a Phase I/II study of a novel antifungal agent. Methods: Six patients with symptoms of confirmed pulmonary coccidioidomycosis of between 8 and 25 days' duration were enrolled in a randomized double-blind study of nikkomycin Z versus placebo. Four patients received nikkomycin Z at 50 mg bid, a dose predicted to have little effect based on animal studies. One patient received 250 mg bid, and one received placebo. Study procedures included assessment of symptoms and laboratory testing every few days over a 28-day period, as well as a chest CT scan at baseline and after 2 or 4 weeks. Results: Cough and chest pain were the most frequent symptoms. Coccidioides was recovered from sputum in 2 of 4 patients where sputum was obtained at enrollment. At end of study, sputum from one patient again yielded the fungus in culture. Peripheral blood eosinophil count was elevated at some time during the study period in 5/6 patients. ESR was normal in 5/6 patients. CRP was mildly elevated in 4/6 patients and declined during the study period. CT scans showed single pulmonary masses in 4/6 patients, with modest decrease in size over a 14 or 28-day period, and development of cavitation in 2/4. One patient had a thin walled pulmonary cavity that persisted. One patient with mild symptoms had multilobar nodular disease on CT scan that was not appreciable on chest X-ray. All patients did well clinically, with most symptoms resolved by day 28. Conclusion: 1) Simple sputum cultures for fungus in patients with even mild illness due to coccidioidomycosis may be diagnostically useful. 2) Despite revealing more extensive disease, CT scans did not contribute significantly to altering management or outcome assessment in early, uncomplicated pulmonary coccidioidomycosis.

    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Susan Hoover, Suzette Chavez, John Galgiani and David Nix, University of Arizona, Tucson, AZ


    S. Hoover, None

    S. Chavez, None

    J. Galgiani, Valley Fever Solutions, Inc: Board Member and Chief Medical Officer, -

    D. Nix, None

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