Coccidioidomycosis in Patients Infected with Human Immunodeficiency Virus: Review of 91 Cases at a Single Institution

Abstract

We retrospectively evaluated the clinical manifestations, diagnosis, treatment, and outcome of coccidioidomycosis in 91 patients infected with human immunodeficiency virus (HIV) at a single institution. Coccidioidomycosis was the AIDS-defining illness in 37 patients. Fever and chills, weight loss, and night sweats were the most frequent symptoms. The lung was the most frequently involved organ (80%), followed by the meninges (15%). A diffuse reticulonodular infiltrate was seen in 59 patients (65%), and 13 (14%) had focal pulmonary disease; for 15 patients (16%), the chest radiograph was normal. Coccidioidal serologies were positive for 60 patients (68%), while for 23% with proven coccidioidomycosis such tests were negative Most patients were treated with systemic amphotericin B and then an oral azole. The mortality for the whole group was 60%. Patients with diffuse pulmonary disease had the highest mortality (68%), with a median duration of survival of 54 days (P < .05; 95% confidence interval, 147-175 days). The presence of diffuse pulmonary disease and a CD4 lymphocyte count of < 50/microL were independent predictors of death. In our experience, coccidioidomycosis is an important opportunistic infection that causes substantial morbidity and mortality among HIV-infected patients living in an area of endemicity.

Serological diagnosis of paracoccidioidomycosis in HIV-coinfected patients

“…This failure has been attributed to B cell dysfunction due to HIV infection (Benard & Duarte 2000), which also impairs the humoral response in opportunistic histoplasmosis (Kauffman 2008), coccidioidomycosis (Singh et al 1996) and aspergillosis ). Surprisingly, some patients with severe cell immunodeficiency respond with high antibody titres, as observed in the present study and in previous reports (Tobon et al 1998).…”

Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis) Associated With Pulmonary Coccidioidomycosis

“…In most cases, the infection is asymptomatic or produces a mild, selflimited respiratory illness. A fulminant course can ensue in immunocompromised patients [10][11][12][13][14][15] or rarely in previously healthy individuals. 9 A variety of cutaneous signs may be seen in association with coccidioidomycosis.…”

Coccidioidomycosis in adolescents with lupus nephritis

“…Together, 90% of infected immunocompetent patients will be either IgM or IgG positive [20]. However, immunocompromised patients, including those with SLE treated with IPC and corticosteroids, may have no detectable antibody even in the context of disseminated [17,21,22]. There are some newer approaches to diagnosing coccidioidomycosis.…”