1577. The Utility of Screening for Coccidioidomycosis in Recipients of Anti-TNF-α Therapy.
Session: Poster Abstract Session: Mycology: Diagnostic
Friday, October 28, 2016
Room: Poster Hall
  • Choi_final_3574099.pdf (2.4 MB)
  • Background:  Tumor necrosis factor-α inhibitors (TNF-I) are commonly used today to treat a wide variety of immune-mediated disorders. These medications are linked with an increased risk of mycobacterial, viral, and fungal infections, and some society guidelines recommend screening for tuberculosis, hepatitis B and C, human immunodeficiency virus, and active life-threatening fungal infections. Patients are also commonly screened for coccidioidomycosis in Arizona.

    Available information regarding coccidioidal infection in the setting of TNF-I is limited to few case reports and retrospective studies. The aim of our study was to determine the number of coccidioidomycosis seropositive patients identified on screening; and to describe what evaluation, treatment, and follow-up transpired for these individuals.

    Methods: We electronically searched for all patients receiving TNF-I from 9/4/2010 to 4/22/2015. The records for seropositive patients were then reviewed in detail.

    Results: 2218 individuals received TNF-I, 994 of whom had screening labs, and 837/994 (84%) had screening coccidioidal serologies performed. Of these, 66/837 (7.9%) were seropositive, and 55/837 (6.6%) met inclusion criteria. 19/55 (35%) were found on initial (pre-TNF-I) screening, 10/55 (18%) on annual screening, and 26/55 (47%) were identified when symptoms were evaluated. Of the 29 new diagnoses of coccidioidomycosis found on screening, 5 (17%) were diagnosed with probable coccidioidomycosis, 5 (17%) were diagnosed with possible coccidioidomycosis, 5 (17%) were diagnosed with asymptomatic seropositivity, and 14 (48%) were diagnosed with EIA IgM of uncertain significance. Of these, 8 (28%) had the initiation of their TNF-I postponed or, in those already on a TNF-I, had their medication discontinued. 12 (41%) were started on an anti-fungal at the time of their diagnosis. There were no cases of dissemination or reactivation in follow-up.

    Conclusion:  Significant resources are used to screen asymptomatic patients prior to and during TNF-I therapy, but infrequently identify active coccidioidal infections that might not have otherwise been identified.

    Kristal Choi, MD, Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, Lester Mertz, MD, Division of Rheumatology, Mayo Clinic Arizona, Scottsdale, AZ, Russell Heigh, MD, Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, James Yiannias, MD, Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ and Janis Blair, MD, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ


    K. Choi, None

    L. Mertz, None

    R. Heigh, None

    J. Yiannias, None

    J. Blair, None

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