Coccidioidomycosis (C) was first recognized in California one hundred years ago this year. As is often the case with discovery of new infectious diseases, early investigators recognized only the severe disseminated tip of the (C) iceberg. It was not until and the work of Gifford that the nature of valley fever and its pathobiologic relationship to disseminated disease was elucidated. In the 100 years since the discovery of this entity substantial progress has been made. Data on the epidemiology, clinical features, treatment, and outcome of nonmeningeal disseminated coccidioidomycosis (NMDC) will be presented.The recent epidemic of (C) has engendered (NMDC) in a large number of patients. Fifty-one patients with (NMDC) have been enrolled since the inception of the Coccidioidomycosis Clinic at Kern Medical Center. Among the 51 patients, distribution of lesions is as follows: skin only 8 (15.6 percent), soft tissue only 11 (21.6 percent), bone only 13 (25.5 percent), joint only 3 (6 percent), skin and soft tissue 1 (2 percent), bone and skin 2 (4 percent), joint and skin 1 (2 percent), bone and soft tissue 5 (9.8 percent), joint and soft tissue 1 (2 percent), skin and meningeal 2 (4 percent), bone, skin, and meningeal 3 (5.9 percent), soft tissue and meningeal 1 (2 percent). Evidence of pulmonary disease was observed in 36 (71 percent). Onset of disseminated disease from pulmonary symptomatology was a mean of 103 days with a range of 0-450 days.Thirty-five of the patients (69 percent) were male. The mean age was 32.5 years. Hispanics comprised 47 percent of the population, African-Americans 31 percent, Caucasians 10 percent, Filipinos 6 percent. Twenty-six individuals tested HIV-negative, and 26 others refused testing or were not tested. The distribution of bone, joint, skin, and soft tissue disease will be presented. Treatment included amphotericin B, azoles, and surgery where appropriate.Currently, 6 patients are without symptoms and off treatment, 26 patients are improved on treatment, 14 patients are lost to follow-up, and 3 patients have expired. No deaths were due to (NMDC).Recent experience with nonmeningeal disseminated coccidioidomycosis is described. Treatment is long, arduous, and not entirely satisfactory. Investigation of new approaches to diagnosis, prevention, and therapy are clearly warranted based upon the significant morbidity produced by this entity.
Full conference title:
Coccidioidomycosis - Centennial Conference