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.
S. Reef, None
L. Snyder, None
A. Freifeld, None
M. Wilson, None
J. Galgiani, None