Sepsis continues to be a leading cause of death in the United States. Rarely, Coccidioides immitis has been reported to cause sepsis. In this report we describe the clinical characteristics and cytokine response in a group of eight patients admitted to Kern Medical Center between August 1991 and December 1993 with septic shock secondary to C. immitis. The three females and five males had a mean age of 59.8 years; one was African- American, two were Filipino and five were Hispanic. All presented with fever, chills, shortness of breath, and a productive: cough. Physical findings included tachycardia, tachypnea, and bilateral crackles. Chest x-rays showed diffuse lung infiltrates. All had negative skin reaction to spherulin. The diagnosis was made by demonstration of C. immitis spherules in the sputum. Cocci serology was positive in 75 percent of the patients. All developed adult respiratory distress syndrome that required mechanical ventilation, and subsequently developed septic shock syndrome multisystem failure. All patients showed leukocytosis with shift to the left and developed lactic acidosis. Fifty percent showed peripheral eosinophilia and 25 percent had hypercalcemia. All the patients died despite initiation of rapid sequence amphotericin B therapy within 24-48 hours of admission. Four patients were analyzed for cytotokines, specifically for IL-1, IL-2, IL-6, and tumor necrosis factor (TNF). All four had undetectable IL-I and IL-2 and elevated TNF and IL-6.CONCLUSION: 1. Septics shock secondary to C. immitis cannot be differentiated from bacterial sepsis clinically. 2. IL-1 is undetectable but IL-6 and TNF are elevated in patients with coccidioidal sepsis. 3. The prognosis of coccidioidal sepsis is much more grave than bacterial sepsis. Cytokine Response in Septic Shock Secondary to Coccidioidomycosis. E. Arsura, Y. Ismail, J. Abraham, P. Bellinghausen, J. Caldwell and R. Johnson. Depart ment of Medicine, Kern Medical Center/UCLA.
Full conference title:
Coccidioidomycosis - Centennial Conference