Program Schedule

1213
Bronchoscopy Findings of Pulmonary coccidioidomycosis

Session: Oral Abstract Session: Fungal Infections
Friday, October 10, 2014: 2:45 PM
Room: The Pennsylvania Convention Center: 109-AB
Background: Coccidioidomycosis is an endemic fungal infection in the Southwestern part of United States. Majority of cases present with pulmonary symptoms. During early stages of disease making decisive diagnosis is essential but difficult and mostly delayed. Fibro optic bronchoscopy has been successfully utilized in prompt and definitive identification of coccidioidomycosis. This study analyzes data from patients with pulmonary coccidioidomycosis who underwent bronchoscopy.

Methods: Retrospective IRB approved chart review. Kern Medical Center’s coccidioidomyosis database of 1541 patients from 2003 to 2014 was used. Cases were defined as patients who underwent bronchoscopy and had either positive serology {Immunodiffusion IgM (IDIgM) or IgG (IDIgG) with Complement Fixation titers (CF) at Kern County Public Health Lab.} or had microbiological or histopathological evidence of coccidioidomycosis. Epi Info 7 was utilized for statistical analysis. 

Results: 98 cases met the criteria. 71 (72%) cases were male. 37 (38%) had diabetes. Most common presenting symptoms were cough 64% (n=63) followed by fever 39% (n=38).  Out of 88 cases who had Chest CT-Scan 34% had cavitary lesions. Simple chest x-ray was positive for cavitation in 19% of patients (n=19). Female patients had increased risk of having cavitary lesions in their chest x-ray; {OR: 5.2(1.8-16) P=0.002}.

Spherules were found only in 7% of sputum samples (3/40) compare to 17% from bronchoscopy samples (16/91); P=0.2. Cultures were positive in 21% of sputum samples (10/47) compare to 74% of samples from bronchoscopy (47/63) P<0.001.  In 22 cases (22%) initial serology was only positive for IDIgG and in 7 (7%) cases all initial serology markers were negative. Patients with positive cultures from any source had increased chance of having CF titers of 8 or higher {OR: 3.3 (1.1-10), P=0.03}.

Direct visualization during bronchoscopy showed 65% presence of mild or moderate bronchitis; 22% presence of mucosal or sub mucosal nodule or lesions. Bronchoscopy samples were positive for presence of endosporulating spherules in 22 cases (22%).  

Conclusion: Bronchoscopy is a valuable diagnostic tool in definitive diagnosis of pulmonary coccidioidomycosis.

Arash Heidari, M.D.1, Augustine Munoz, MD2, Rhonda Alkatib, M.D.1, Negin Sobhani, MS IV1, Daisy Lankarani, MS III1 and Shaker Qaqish, M.D.1, (1)Infectious Diseases, Kern Medical Center/UCLA, Bakersfield, CA, (2)Pulmonary and Critical Care Medicine, Kern Medical Center/UCLA, Bakersfield, CA

Disclosures:

A. Heidari, None

A. Munoz, None

R. Alkatib, None

N. Sobhani, None

D. Lankarani, None

S. Qaqish, None

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See more of: Oral Abstract Session

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