1819. A Prospective Observational Study of Symptomatic Patients with Mild-Moderate Primary Pulmonary Coccidioidomycosis
Session: Oral Abstract Session: Fungal Infections
Saturday, October 5, 2013: 2:00 PM
Room: The Moscone Center: 300
Background: Coccidioidomycosis is a fungal infection endemic to the southwestern USA. Primary pulmonary coccidioidomycosis (PPC) accounts for 15-29% of community acquired pneumonia in the endemic area, but there has never been a study of the temporal sequence of symptoms (sx) or time to sx resolution. Our aim was to describe the evolution of symptoms and laboratory changes in otherwise healthy patients with PPC.

Methods: A 24 week prospective, IRB approved, study was conducted for patients with symptomatic PPC of < 2 months in duration, including both patients with or without antifungal treatment. Treatment decisions were made prior to entrance into study. Hospitalized patients or those with disseminated infection were excluded, as were those with immunosuppression, hematological malignancies, diabetes, or underlying heart, liver, lung, or kidney disease. 

Results: From March 2010 - October 2012, 38 patients provided informed consent. 47% were male, 92% Caucasian, median age 53 years. 19 (50%) patients had received treatment at baseline. Other than a history of chills, there were no other differences in baseline sx in the treated and untreated groups, although the total sx score was higher for the treated than the untreated cohort (p<0.02). The median times to 50% reduction and complete resolution of sx was 6.6 and 13 weeks from enrollment, respectively.  Time to 50% reduction in fatigue was 6 weeks and none had resolved fatigue by 24 weeks.  The time to full attendance at work and school was 3.5 and 7.0 weeks.  Treated patients did not achieve 1o or 2oendpoints faster than untreated patients. The percentage with detectable complement fixing (CF) antibody at baseline, 4, 12, and 24 weeks was 38, 60, 61 and 18 respectively.  Peak CF titers occurred at 4 weeks post-enrollment, ranging 1:2 – ≥1:32. Resolution of radiographic (CXR) abnormalities, as reflected in mean CXR scores, declined from 2.1 baseline to 1.4 at week 24; >50% had residual CXR abnormalities at 24 weeks. No patient experienced disseminated infection.

Conclusion: For otherwise healthy adults with mild to moderate PPC, sx resolution was prolonged, and without significant differences between treated & untreated cohorts.

Janis Blair, MD1, Yu-Hui Chang, PhD2, Meng-Ru Cheng2, Shimon Kusne, MD1, Maria Teresa Seville, MD1, Holenarasipur R. Vikram, MD, FACP1, Robert Orenstein, DO1, Laszlo Vaszar, MD3, Stanford Ho, MD4 and James Parish, MD3, (1)Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ, (2)Research & Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ, (3)Pulmonary Medicine, Mayo Clinic Arizona, Scottsdale, AZ, (4)Arizona State University, Tempe, AZ

Disclosures:

J. Blair, None

Y. H. Chang, None

M. R. Cheng, None

S. Kusne, None

M. T. Seville, None

H. R. Vikram, None

R. Orenstein, None

L. Vaszar, None

S. Ho, None

J. Parish, None

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