Coccidioidomycosis In A Cancer Hospital

Abstract

Study objective: Coccidioidomycosis is a fungal disease that is known to cause pulmonary complications and significant derangement in immunocompromissed hosts. We conducted this study to evaluate the behavior of this disease in our unique patient population.Design: A retrospective clinical study.Patients and setting: We studied the records of all patients with coccidioidomycosis diagnosed at The University of Texas, M.D. Anderson Cancer Center, a university tertiary hospital from January 1956 to December 1994.Results: We obtained 20 record numbers of patients with coccidioidomycosis. Fifteen patients (75%) were asymptomatic with an abnormal chest-X ray. Five patients (25%) had: chest pain (2), dyspnea (1), cough (1), and weight loss (1). Solitary pulmonary nodule was found is 55% of patients, followed by focal infiltrates (25%), multiple nodules (10%), and cavitary lesions (10%). The diagnostic procedures were Open lung biopsy (OPL), Fine needle aspiration (FNA), Bronchoscopy, and Serology. Higher sensitivities were associated with OPL and FNA. Sixteen patients underwent a thoracotomy as a diagnostic and therapeutic procedure. Three patients were medically treated with fluconazole, and one was lost to follow up. None of our patients were in the immunosupressed category.Conclusions: Coccidioidomycosis has a relatively infrequent occurrence in our patient population. Bronchoscopy and serology had low diagnostic yields. Transthoracic fine needle aspiration (FNA) needs to be considered, since coccidioidomycosis does respond to medical treatment, in order to avoid unnecessary ablative surgery. Abbreviations: FNA = Fine needle aspiration. OPL = Open lung biopsy.