How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

Abstract

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides spp. and increased international travel to endemic regions. The majority of individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will develop primary pulmonary coccidioidomycosis (PCM) with signs and symptoms that mimic community acquired pneumonia (CAP) or other respiratory illnesses. Further, 5% of those diagnosed will develop serious and even life-threatening manifestations including extrapulmonary/disseminated coccidioidomycosis (DCM). Of those who develop PCM, past evidence suggests ∼ 5% to 15% will develop long-term pulmonary sequelae in the form of nodules, abscesses, or cavitary lesions. These lesions may not be easily distinguished from malignancy or other infections, such as tuberculosis, and they add a substantial burden to both patients and the healthcare system. Despite the long-term consequences of cavitary CM in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report we will focus on cavitary lesions in CM with the goal to present a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.