A Clinicopathological Categorization System for Clinical Research in Coccidioidomycosis

Abstract

A wide array of clinical manifestations follow infection with Coccidioides immitis or Coccidioides posadasii, ranging from asymptomatic infection to life-threatening pulmonary disease or extrapulmonary dissemination and meningitis. Epidemiological studies require consistent definitions of cases and their comparative clinical features. Understanding host and pathogen determinants of the severity of coccidioidomycosis also requires that specific clinical features (such as coccidioidal meningitis) and their overlap be precisely defined and quantified. Here we propose a system for categorization of outcomes of coccidioidomycosis in individuals who are not overtly immunocompromised that harmonizes clinical assessments during translational research of this increasingly common disease.

The Host Response to Coccidioidomycosis

“…Although the majority of studies have been done in mice, understanding the human host responses to infection is the ultimate goal and many more human studies are needed. Understanding the immune response in different groups of patients requires large sample sizes and careful clinical categorization, and a tool for that has recently been published [ 126 ]. Vaccine studies, in particular, illustrate that we need to be cautious about the strengths and limitations of our models and the importance of different types of immune responses.…”

The Known and Unknown “Knowns” of Human Susceptibility to Coccidioidomycosis

“…Dissemination is estimated to occur in 600-1000 individuals of the ~150,000 believed to become infected each year (0.4-0.6%) [3]. Recently, a new framework was published which divides extrapulmonary dissemination into two categories depending on central nervous system (CNS) dissemination and includes a separate category for death from coccidioidomycosis [5]. This increased granularity in patient description will be beneficial in comparing and grouping cases for additional translational or meta-analysis.…”