Fungemia due to Coccidioides immitis. An analysis of 16 episodes in 15 patients and a review of the literature

Sixteen episodes of fungemia due to Coccidioides immitis were identified in 15 patients over a 7-year period at 2 hospital associated with the University of Arizona in Tucson. Fourteen of the 15 patients were male and 13 had an underlying condition, including malignancy in 6 and AIDS in 3. Ten of th...

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Bibliographic Details
Published in:Medicine (Baltimore) 1986-09, Vol.65 (5), p.312-321
Main Authors: Ampel, N M, Ryan, K J, Carry, P J, Wieden, M A, Schifman, R B
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome - complications
Adult
Aged
AIDS/HIV
Coccidioides
Coccidioidomycosis - complications
Coccidioidomycosis - diagnosis
Coccidioidomycosis - microbiology
Humans
Lung - diagnostic imaging
Male
Radiography
Sepsis - complications
Sepsis - diagnosis
Sepsis - microbiology
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Summary:Sixteen episodes of fungemia due to Coccidioides immitis were identified in 15 patients over a 7-year period at 2 hospital associated with the University of Arizona in Tucson. Fourteen of the 15 patients were male and 13 had an underlying condition, including malignancy in 6 and AIDS in 3. Ten of the patients were receiving corticosteroids at the time of fungemia. TP antibodies were present in 5 of 9 episodes and some titer of CF antibody was present in 7 of 11 instances. None of the 10 patients tested had a positive 1:100 coccidioidin skin test. In 11 of 15 episodes, a miliary chest roentgenographic pattern was apparent at the time of fungemia. Eleven of the 16 episodes ended in death within 1 month of the positive blood culture. Fungemic patients were compared to patients with culture-proven coccidioidomycosis without fungemia and differed from them significantly in 3 respects. First, fungemic patients were more likely to have a diffuse miliary pattern on chest radiograph. Second, all fungemic patients had, by definition, disseminated coccidioidomycosis and this was more likely among fungemic patients than among non-fungemic patients. Finally, fungemic patients were more likely to die within 1 month of the positive culture for C. immitis. Fungemia occurred in greater than 30% of patients with culture-proven coccidioidomycosis who had a blood culture performed. These results suggest that coccidioidal fungemia is a marker for a severe, acute form of disseminated coccidioidomycosis associated with a high mortality.
ISSN:0025-7974
DOI:10.1097/00005792-198609000-00004