Fatigue in coccidioidomycosis. Quantification and correlation with clinical, immunological, and nutritional factors

Abstract

While described in the past, the frequency and degree of fatigue associated with symptomatic coccidioidomycosis has never been quantified. Using the Fatigue Severity Scale (FSS), severe fatigue (FSS score = 41) was found in 65% of cases of active coccidioidomycosis compared to 42% in cohort of control subjects with chronic medical diseases (P=0.024). Fatigue in patients with symptomatic coccidioidomycosis declined significantly over four months (P=0.023). Severe fatigue in patients with symptomatic coccidioidomycosis was significantly associated with low body mass index (BMI; P=0.024) but was not significantly associated with either serum leptin (r2=0.078, P=0.261) or serum TNF-alpha (r2=0.028, P=0.504) concentrations. Severe fatigue is a common condition among patients with active coccidioidomycosis and is associated with a declining BMI.

Characteristics of Patients with Mild to Moderate Primary Pulmonary Coccidioidomycosis

“…Other investigators have demonstrated a median time of 95–98 days (roughly 14 weeks) to 50% resolution of symptoms ( 11 ). Still others have found that fatigue is severe at baseline and 4 months later ( 10 ) and that >25% of otherwise healthy college students with primary coccidioidomycosis required medical care for at least 4 months ( 22 ). Although our study focused only on persons with mild to moderate infection and no substantial concurrent conditions, results are similar to those of previous studies (long duration of symptoms, fatigue, and illness caused by primary coccidioidal infection).…”

“…When this score declined to 50% of the enrollment score for 2 consecutive weeks, symptoms were assessed every 2 weeks for 2 episodes, then monthly for 6-month follow-up visits. Baseline and monthly fatigue levels were assessed by using the fatigue severity scale ( 10 , 18 ), and health-related quality of life was assessed by using the 36-Item Short Form Health Survey ( 19 ). Full-time or part-time attendance at work or school was recorded during assessments.…”

“…Differentiating coccidioidal infection from pneumonia caused by viruses or bacteria is difficult. However, unlike other causes of community-acquired pneumonia, coccidioidomycosis is characterized by slow resolution of symptoms and extreme fatigue ( 10 , 11 ). …”

Pulmonary Coccidioidomycosis: Pictorial Review of Chest Radiographic and CT Findings

“…The most common symptoms are cough, fever, headache, and chest pain, each occurring in more than 70% of patients (23). Helpful clinical symptoms are night sweats and prolonged fatigue, which may take months to resolve (2,37). Approximately 25% of white women and 4% of white men develop "valley fever," an allergic syndrome characterized by hypersensitive skin lesions, such as erythema multiforme or erythema nodosum, and polyserositis (10).…”

Oxygen Consumption Deficits in Patients With Residual Fatigue After Primary Coccidioidomycosis

“…Previous studies addressing fatigue in this population have been limited to subjective reports [3, 4]. In this report, we conducted physiologic measurements (ie, strength, pulmonary function, exercise capacity, gas exchange) in 5 individuals with self-reported fatigue after coccidioidal pneumonia without evidence of hematogenous dissemination.…”