386. A Reexamination of Disseminated Coccidioidomycosis: The Natural History in the Pre-Antifungal Era
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Screen Shot 2018-09-26 at 9.44.50 PM.png (874.4 kB)
  • Background: While it has been previously well described that central nervous system (CNS) coccidioidomycosis (CM) is nearly always fatal without treatment, the natural history of non-CNS disseminated coccidioidomycosis (DCM) infections is not well characterized. The historical VA-Armed forces CM patient group provides a unique cohort of patients not treated with standard antifungals to characterize the natural history of non-CNS DCM.

    Methods: We conducted a retrospective study of 595 VA-Armed forces CM patients diagnosed between 1955-1958 and followed to 1966. Cohorts were identified as non-disseminated disease (487 patients), non-CNS DCM (72 patients), and CNS DCM (36). A combination of statistical analyses were used to compare demographic information, laboratory data including serologies and complete blood count data, symptom severity, fate of primary infection, and mortality.

    Results: There were significant differences in the ethnicity between the cohorts with trends towards increased Black and Filipino patients in the disseminated cohorts (p-value <0.001). There was a trend showing increased frequency of leukocytosis regardless of eosinophilia in the disseminated cohorts (p-value 0.009). Patients with disseminated disease presented with more severe symptoms (p-value 0.006). Primary fate of infection demonstrated decreased rates of residual pulmonary nodule in DCMs: 38.19% in non-DCM, 13.89% in non-CNS DCM, and 19.44% in CNS DCM (p-value <0.001). In addition, there were decreased rates of residual cavities in DCM: 33.26% in non-DCM, 8.33% in non-CNS DCM, and 8.33% in CNS DCM (p-value <0.001). Forty-five percent and 53% of patients in the non-CNS DCM and CNS DCM cohorts, respectively, developed dissemination with initial infection. Mortality at last known follow up due to CM was significantly different across the cohorts: 1.03% in non-DCM, 15.28% in non-CNS DCM, and 77.78% in CNS DCM (p-value <0.001).

    Conclusion: This large retrospective cohort study helps further characterize the natural history of non-CNS DCM in comparison to CNS DCM in a population that was not treated with conventional antifungal therapy. While not as fatal as CNS DCM, non-CNS DCM shares many characteristics and has a high associated morbidity.

    Derek Bays, MD, University of California - Davis, Davis, CA, George R. Thompson, MD, Medical Microbiology and Immunology, University of California, Davis, Davis, CA, Susan Reef, MD, CDC, Atlanta, GA, Linda Snyder, MD, Pulmonary/Critical Care and Palliative Medicine, University of Arizona, Tucson, AZ, Alana Freifeld, BS, California Northstate University School of Medicine, Sacramento, CA, Machelle Wilson, PhD, Division of Biostatistics, University of California, Davis, Sacramento, CO and John Galgiani, MD, University of Arizona, Tuscon, AZ

    Disclosures:

    D. Bays, None

    G. R. Thompson, None

    S. Reef, None

    L. Snyder, None

    A. Freifeld, None

    M. Wilson, None

    J. Galgiani, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.