The Clinical Course Following the Use of Corticosteroids for Symptomatic Relief of Primary Pulmonary Coccidioidomycosis in Immunocompetent Persons

Ref ID: 18788

Author:

N. Azadeh, MD – Internal Medicine Resident, S. Kusne, MD – Consultant Infect Dis, H. Vikram, MD – Consultant Inf Dis, M. Seville, MD – Consultant Inf Dis, R. Orenstein, DO – Consultant Inf Dis, J. E. Blair, MD – Consultant Inf Dis;

Author address:

Mayo Clinic Arizona, Phoenix, AZ.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Coccidioidomycosis (CM) is an endemic fungal infection of the desert southwestern US. Primary pulmonary CM manifests as a febrile respiratory syndrome of varying severity, often mistaken for community acquired bacterial pneumonia. The diagnosis is commonly entertained and sought after the patient’s clinical course is prolonged or lacks response to empiric antibacterial treatment. Immunosuppression (including corticosteroids) is a known risk factor for severe or disseminated infection. Previous studies of the impact of steroid use on the course of CM have focused on patients who were chronic recipients of such immunosuppression, and the effect of corticosteroids for the relief of CM-related symptoms on the clinical course of CM is not known. Our aim was to describe the clinical course of immunocompetent persons whose acute symptoms of primary pulmonary CM were treated with corticosteroids. Methods: A retrospective chart review was conducted of immunocompetent patients with acute CM who received systemic steroids for relief of CM-related symptoms or signs, from 1/1/2006-12/31/2011. This study was approved by Mayo Clinic Institutional Review Board. Results: 74 patient met inclusion criteria. Cumulative steroid doses ranged 20-3600 mg (median 150) of prednisone. Corticosteroids were prescribed by primary care or urgent/emergency providers equally (42%) and most commonly for rash (58%) or asthma/wheeze (18%). 81% received delayed antifungal treatment after the steroids were initiated, for a mean duration of 32 weeks (range 0.5-208). 26% of patients required subsequent CM-related hospitalization. CM-related symptoms resolved within a median duration of 8 weeks (range 2 – 56). 12% experienced relapsed CM, and 10% had extrapulmonary dissemination. Conclusions: The use of corticosteroids for the relief of acute CM-related symptoms was complicated by CM-related hospitalization, relapse and extrapulmonary dissemination.

Abstract Number: M-1697

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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