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Janis E Blair - One of the best experts on this subject based on the ideXlab platform.
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261. A Retrospective Evaluation of Coccidioidomycosis Skin Testing in Patients with Pulmonary Coccidioidomycosis in an Endemic Region
Open Forum Infectious Diseases, 2019Co-Authors: Neema Mafi, Marlene Girardo, Janis E BlairAbstract:Abstract Background Making the decision to stop antifungal therapy in patients with Coccidioidomycosis can be challenging in patients with risk factors for relapsed infection. Spherulin-based coccidioidal skin testing was re-introduced to the market in 2014 and approved for the detection of delayed-type hypersensitivity in patients with a history of Pulmonary Coccidioidomycosis Methods We searched electronically for patients who had a spherulin skin test placed in our institution from January 1, 2015 through March 1, 2017, and then included patients age 18 years and older who met the definition for confirmed or probable Pulmonary Coccidioidomycosis. A retrospective chart review was conducted, and included details of clinical illness, antifungal treatment, serology, and chest imaging Results From January 1, 2015 to August 31, 2017, 172 patients with Coccidioidomycosis had a spherulin skin test placed. We included for further study the 129 patients who had Primary Pulmonary Coccidioidomycosis, followed for a median of 18 months (range 0–50 months); 56 (43.4/%) were male, 108 (85.7/%) Caucasian, median age was 55 years (range18–89).19/12914.7%)) were smokers, 14/129 (10.9%) were diabetic, 2 patients had HIV (1.6%) and 15/129 (11.6) we immunocompromised without HIV. 116/129(89.9%) % received antifungal treatment. Median time from illness to skin test was 13.5 months (range 0–78). Eighty-nine of 129 patients (69%) had a positive skin test, 40 (31%) had a negative test. Antifungal treatment was subsequently discontinued in 75/89 (84%), and one patient (1.2%) with a positive test, experienced relapsed infection. Among 30/40 with negative CST, antifungals were discontinued and none relapsed. Conclusion The presence of delayed-type hypersensitivity to Coccidioidomycosis, manifested by a positive spherulin skin test, was associated with discontinuation of antifungal therapy, and a low percentage of relapsed infection. Disclosures All authors: No reported disclosures.
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Coccidioides (spherulin) skin testing in patients with Pulmonary Coccidioidomycosis in an endemic region
Medical Mycology, 2019Co-Authors: Neema Mafi, C Brian Murphy, Marlene Girardo, Janis E BlairAbstract:Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. Intact cellular immunity is critical to the control of this infection. A recently released reformulated spherulin antigen (Spherusol; Nielsen BioSciences, Inc.) was approved to detect delayed-type hypersensitivity, which implies the presence of cellular immunity, to Coccidioides species. We aimed to summarize our experience with this test in patients with Primary Pulmonary Coccidioidomycosis. We retrospectively reviewed clinical data for all patients with Primary Pulmonary Coccidioidomycosis who had a Coccidioides (spherulin) skin test (CST) placed at our institution between January 1, 2015, and August 31, 2017. During the study period, 172 patients had a CST placed, and 122 met our inclusion criteria for proven or probable Pulmonary Coccidioidomycosis. Of these 122, 88 (72.1%) had a positive CST result and 34 (27.9%) had a negative result. In the positive CST group, 74 of the 79 treated patients (93.7%) had antifungal treatment stopped, 1 of whom (1.4%) had relapsed infection. In contrast, 27 of the 33 treated patients in the negative CST group (81.8%) had their antifungal treatment stopped, and none had a relapse. Seven patients overall (5.7%), all of whom had a positive CST, experienced mild local adverse reactions to the CST. Although previous controlled studies of CST showed sensitivity and specificity greater than 98%, our real-world experience with the CST showed lower rates of positivity. Negative CST results did not predict relapse with antifungal agent withdrawal.
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Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success?
Clinical Infectious Diseases, 2019Co-Authors: John N Galgiani, Neil M Ampel, Janis E Blair, George Richard ThompsonAbstract:: The care of Primary Pulmonary Coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extraPulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
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Coccidioidomycosis in Patients with Selected Solid Organ Cancers: A Case Series and Review of Medical Literature
Mycopathologia, 2016Co-Authors: Colin Fitterer, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Maria Teresa Seville, Zachary Berg, Thorvardur R. Halfdanarson, Janis E BlairAbstract:Coccidioidomycosis is a common infection in the desert southwestern USA; approximately 3 % of healthy persons in Arizona alone become infected annually. Coccidioidomycosis may be severe in immunocompromised persons, but experience among patients with solid organ cancer has not been fully described. Therefore, we aimed to describe the clinical courses of patients whose cancers were complicated by Coccidioidomycosis at our institution, which is located in an area with endemic Coccidioides . To do so, we conducted a retrospective review from January 1, 2000, through December 31, 2014, of all patients with breast, colorectal, or ovarian cancer whose cancer courses were complicated by Coccidioidomycosis. We identified 17,576 cancer patients; 14 (0.08 %) of these patients met criteria for proven or probable Coccidioidomycosis diagnosed within the first 2 years after the cancer diagnosis. All of these patients had Primary Pulmonary Coccidioidomycosis, none had relapsed prior infection, and 1 had possible extraPulmonary dissemination. Five had active coccidioidal infection during chemotherapy, 1 of whom was hospitalized for coccidioidal pneumonia. All were treated with fluconazole, and all improved clinically. Eleven did not require prolonged courses of fluconazole. There were no clearly demonstrated episodes of relapsed infection. In conclusion, Coccidioidomycosis was not a common complication of breast, colorectal, or ovarian cancers in patients treated at our institution, and it was not commonly complicated by severe or disseminated infection.
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Uphill both ways: Fatigue and quality of life in valley fever.
Medical Mycology, 2015Co-Authors: Ashley L. Garrett, Yu Hui H Chang, Kathleen J. Ganley, Janis E BlairAbstract:: Primary Pulmonary Coccidioidomycosis is characterized by prolonged respiratory and systemic symptoms and fatigue. We prospectively administered the fatigue severity scale (FSS) and Short Form-36 Health Status Questionnaire (SF-36) to patients with proven or probable Primary Pulmonary Coccidioidomycosis to quantify disease effect on quality of life (QOL). The 24-week observational study did not specify whether antifungal treatment would be provided; the treating physician made treatment decisions. FSS and SF-36 were completed at 4-week intervals. Thirty-six patients participated, of whom 20 received antifungal treatment. At onset of coccidioidal illness, mean FSS score was higher (ie, more fatigue) in the treatment group. However, in early illness, both groups had higher fatigue levels than reference populations with other diseases (eg, multiple sclerosis). FSS scores gradually improved, and scores in each group were below the severe fatigue level at week 12 and week 16 in the nontreatment and treatment groups, respectively. By week 24, mean FSS score of the nontreatment group equaled the general population. SF-36 component and profile scores were lower (with more symptoms) in the treatment group at each time point than the nontreatment group; both groups showed similar improvement. Mental and emotional health SF-36 scores were not as severely affected as physical scores. Most patients reached a physical functioning level similar to the general population at week 12. Pulmonary Coccidioidomycosis causes severe fatigue and substantially affects physical abilities. Fatigue was found to be prolonged, with gradual improvement in QOL, regardless of antifungal administration.
Neil M Ampel - One of the best experts on this subject based on the ideXlab platform.
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Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success?
Clinical Infectious Diseases, 2019Co-Authors: John N Galgiani, Neil M Ampel, Janis E Blair, George Richard ThompsonAbstract:: The care of Primary Pulmonary Coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extraPulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
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ex vivo cytokine release determined by a multiplex cytokine assay in response to coccidioidal antigen stimulation of whole blood among subjects with recently diagnosed Primary Pulmonary Coccidioidomycosis
mSphere, 2018Co-Authors: Neil M Ampel, Ian F Robey, Chinh Nguyen, Brentin Roller, Jessica August, Kenneth S Knox, Demosthenes PappagianisAbstract:ABSTRACT The elements of the cellular immune response in human Coccidioidomycosis remain undefined. We examined the ex vivo release of an array of inflammatory proteins in response to incubation with a coccidioidal antigen preparation to ascertain which of these might be associated with diagnosis and outcome. Patients with a recent diagnosis of Primary Pulmonary Coccidioidomycosis and a control group of healthy subjects were studied. Blood samples were incubated for 18 h with T27K, a soluble coccidioidal preparation containing multiple glycosylated antigens, and the supernatant was assayed for inflammatory proteins using the multiplex Luminex system. The presentation and course of illness were compared to the levels of the inflammatory proteins. Among the 31 subjects studied, the median time from diagnosis to assay was 15 days. Of the 30 inflammatory proteins measured, the levels of only 7 proteins, granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 receptor alpha (IL-1RA), interleukin-1β (IL-1β), interferon gamma (IFN-γ), IL-2, IL-13, and tumor necrosis factor alpha (TNF-α), were more than 10-fold above the levels seen without antigen stimulation. The levels of IFN-γ and IL-2 were significantly elevated in those subjects not receiving triazole antifungal therapy compared to those who were receiving triazole antifungal therapy. While the levels of IL-1RA were nonspecifically elevated, elevated levels of IL-13 were seen only in those with active Pulmonary Coccidioidomycosis. Only six cytokines were specifically increased in subjects with recently diagnosed Primary Pulmonary Coccidioidomycosis. While IFN-γ, IL-2, and TNF-α have been previously noted, the finding of elevated levels of the innate cytokines GM-CSF and IL-1β could suggest that these, as well as IL-13, are early and specific markers for Pulmonary Coccidioidomycosis. IMPORTANCE Coccidioidomycosis, commonly known as Valley fever, is a common pneumonia in the southwestern United States. In this paper, we examined the release of 30 inflammatory proteins in whole-blood samples obtained from persons with coccidioidal pneumonia after the blood samples were incubated with a preparation made from the causative fungus, Coccidioides . We found that six of these proteins, all cytokines, were specifically released in high concentrations in these patients. Three of the cytokines were seen very early in disease, and an assay for all six might serve as a marker for the early diagnosis of Valley fever.
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Mannose-Binding Lectin Serum Levels are Low in Persons with Clinically Active Coccidioidomycosis
Mycopathologia, 2009Co-Authors: Neil M Ampel, Andrea Giblin, Sara O. Dionne, Abigail B. Podany, John GalgianiAbstract:Background Mannose-binding lectin (MBL) is a circulating collectin that is part of the innate immune response. We explored the serum levels of MBL in persons with different forms of Coccidioidomycosis. Methods Serum MBL was measured by ELISA from samples obtained from healthy donors with immunity to Coccidioides , and those with various forms of active Coccidioidomycosis. Blood cell specimens from a subgroup of subjects with active Coccidioidomycosis were examined for single nucleotide polymorphisms of the MBL gene and promoter regions. Results The control group comprised 29 healthy immune subjects. Patient groups with active Coccidioidomycosis consisted of 20 patients with symptomatic Primary Pulmonary Coccidioidomycosis, 26 with non-meningeal disseminated Coccidioidomycosis, and nine with coccidioidal meningitis. The group with active Coccidioidomycosis was significantly older and more likely to be male than the control group (for both, P
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factors and outcomes associated with the decision to treat Primary Pulmonary Coccidioidomycosis
Clinical Infectious Diseases, 2009Co-Authors: Neil M Ampel, Andrea Giblin, John P Mourani, John N GalgianiAbstract:Background Studies that assess the value of initiating oral antifungal therapy to treat Primary Pulmonary Coccidioidomycosis have not been published previously. Methods Prospectively collected observational data were analyzed from patients with Primary Pulmonary Coccidioidomycosis who attended a single clinic devoted to the management of Coccidioidomycosis that is located in a region of coccidioidal endemicity. Results Fifty-four of 105 patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy, whereas 51 were not. No statistically significant differences were found between the 2 groups with regard to age, ethnicity, sex, or the presence or type of underlying diseases (for all, P > .100). Treated patients had a higher total clinical score (P = .001), had a higher symptom score (P = .049), and were more likely to have a culture of sputum that was positive for Coccidioides species (P = .048), compared with patients who were not prescribed therapy. There was prospective in-clinic follow-up for 43 patients, for a median duration of 286 days (range, 35-1124 days). The health of all 16 patients who were not treated improved after a median of 217 days, and no patients developed complications during follow-up. However, 2 of 20 patients who were treated but whose therapy was subsequently stopped developed disseminated disease. The rate of clinical improvement was similar in treated and untreated patients (P = .899). A retrospective follow-up of 58 of the remaining 62 patients identified 6 additional patients with complications, all from the group that was initially treated but whose therapy was subsequently discontinued. Conclusions Approximately one-half of patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy on the basis of clinical severity. Complications were seen only among patients in the group that was prescribed therapy but whose treatment was discontinued.
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factors and outcomes associated with the decision to treat Primary Pulmonary Coccidioidomycosis
45th Annual Meeting, 2007Co-Authors: Neil M Ampel, Andrea Giblin, John P Mourani, John N Galgiani, Arizona VeteransAbstract:Background. Studies that assess the value of initiating oral antifungal therapy to treat Primary Pulmonary Coccidioidomycosis have not been published previously. Methods. Prospectively collected observational data were analyzed from patients with Primary Pulmonary Coccidioidomycosis who attended a single clinic devoted to the management of Coccidioidomycosis that is located in a region of coccidioidal endemicity. Results. Fifty-four of 105 patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy, whereas 51 were not. No statistically significan differences were found between the 2 groups with regard to age, ethnicity, sex, or the presence or type of underlying diseases (for all, ). Treated patients had a higher P 1 .100 total clinical score ( ), had a higher symptom score ( ), and were more likely to have a culture P p .001
John N Galgiani - One of the best experts on this subject based on the ideXlab platform.
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Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success?
Clinical Infectious Diseases, 2019Co-Authors: John N Galgiani, Neil M Ampel, Janis E Blair, George Richard ThompsonAbstract:: The care of Primary Pulmonary Coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extraPulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
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factors and outcomes associated with the decision to treat Primary Pulmonary Coccidioidomycosis
Clinical Infectious Diseases, 2009Co-Authors: Neil M Ampel, Andrea Giblin, John P Mourani, John N GalgianiAbstract:Background Studies that assess the value of initiating oral antifungal therapy to treat Primary Pulmonary Coccidioidomycosis have not been published previously. Methods Prospectively collected observational data were analyzed from patients with Primary Pulmonary Coccidioidomycosis who attended a single clinic devoted to the management of Coccidioidomycosis that is located in a region of coccidioidal endemicity. Results Fifty-four of 105 patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy, whereas 51 were not. No statistically significant differences were found between the 2 groups with regard to age, ethnicity, sex, or the presence or type of underlying diseases (for all, P > .100). Treated patients had a higher total clinical score (P = .001), had a higher symptom score (P = .049), and were more likely to have a culture of sputum that was positive for Coccidioides species (P = .048), compared with patients who were not prescribed therapy. There was prospective in-clinic follow-up for 43 patients, for a median duration of 286 days (range, 35-1124 days). The health of all 16 patients who were not treated improved after a median of 217 days, and no patients developed complications during follow-up. However, 2 of 20 patients who were treated but whose therapy was subsequently stopped developed disseminated disease. The rate of clinical improvement was similar in treated and untreated patients (P = .899). A retrospective follow-up of 58 of the remaining 62 patients identified 6 additional patients with complications, all from the group that was initially treated but whose therapy was subsequently discontinued. Conclusions Approximately one-half of patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy on the basis of clinical severity. Complications were seen only among patients in the group that was prescribed therapy but whose treatment was discontinued.
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factors and outcomes associated with the decision to treat Primary Pulmonary Coccidioidomycosis
45th Annual Meeting, 2007Co-Authors: Neil M Ampel, Andrea Giblin, John P Mourani, John N Galgiani, Arizona VeteransAbstract:Background. Studies that assess the value of initiating oral antifungal therapy to treat Primary Pulmonary Coccidioidomycosis have not been published previously. Methods. Prospectively collected observational data were analyzed from patients with Primary Pulmonary Coccidioidomycosis who attended a single clinic devoted to the management of Coccidioidomycosis that is located in a region of coccidioidal endemicity. Results. Fifty-four of 105 patients with Primary Pulmonary Coccidioidomycosis were prescribed antifungal therapy, whereas 51 were not. No statistically significan differences were found between the 2 groups with regard to age, ethnicity, sex, or the presence or type of underlying diseases (for all, ). Treated patients had a higher P 1 .100 total clinical score ( ), had a higher symptom score ( ), and were more likely to have a culture P p .001
Yu Hui H Chang - One of the best experts on this subject based on the ideXlab platform.
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Uphill both ways: Fatigue and quality of life in valley fever.
Medical Mycology, 2015Co-Authors: Ashley L. Garrett, Yu Hui H Chang, Kathleen J. Ganley, Janis E BlairAbstract:: Primary Pulmonary Coccidioidomycosis is characterized by prolonged respiratory and systemic symptoms and fatigue. We prospectively administered the fatigue severity scale (FSS) and Short Form-36 Health Status Questionnaire (SF-36) to patients with proven or probable Primary Pulmonary Coccidioidomycosis to quantify disease effect on quality of life (QOL). The 24-week observational study did not specify whether antifungal treatment would be provided; the treating physician made treatment decisions. FSS and SF-36 were completed at 4-week intervals. Thirty-six patients participated, of whom 20 received antifungal treatment. At onset of coccidioidal illness, mean FSS score was higher (ie, more fatigue) in the treatment group. However, in early illness, both groups had higher fatigue levels than reference populations with other diseases (eg, multiple sclerosis). FSS scores gradually improved, and scores in each group were below the severe fatigue level at week 12 and week 16 in the nontreatment and treatment groups, respectively. By week 24, mean FSS score of the nontreatment group equaled the general population. SF-36 component and profile scores were lower (with more symptoms) in the treatment group at each time point than the nontreatment group; both groups showed similar improvement. Mental and emotional health SF-36 scores were not as severely affected as physical scores. Most patients reached a physical functioning level similar to the general population at week 12. Pulmonary Coccidioidomycosis causes severe fatigue and substantially affects physical abilities. Fatigue was found to be prolonged, with gradual improvement in QOL, regardless of antifungal administration.
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serum procalcitonin levels in patients with Primary Pulmonary Coccidioidomycosis
Annals of the American Thoracic Society, 2014Co-Authors: Kenneth K Sakata, Holenarasipur R Vikram, Yu Hui H Chang, Thomas E Grys, Janis E BlairAbstract:Rationale: The serum procalcitonin assay has emerged as a promising biomarker to distinguish between bacterial and viral respiratory tract infections but has not been used to differentiate Coccidioidomycosis from bacterial infection. A correlation between procalcitonin serum levels and Coccidioidomycosis has never been reported.Objective: To determine any association between serum procalcitonin levels and Primary Pulmonary Coccidioidomycosis.Methods: We identified and enrolled 20 immunocompetent patients with symptomatic Primary Pulmonary Coccidioidomycosis of < 8 weeks’ duration and performed a one-time procalcitonin assay, with a cutoff of < 0.25 μg/L indicating a nonbacterial infection.Measurements and Main Results: Nineteen of 20 patients (95%) had serum procalcitonin of < 0.25 μg/L. The median procalcitonin level was 0.05 μg/L (range, < 0.05–0.87 μg/L; interquartile range, 0.05–0.05 μg/L). Sixteen of 20 patients (80%) had undetectable procalcitonin of < 0.05 μg/L. The four patients with detectable pr...
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characteristics of patients with mild to moderate Primary Pulmonary Coccidioidomycosis
Emerging Infectious Diseases, 2014Co-Authors: Janis E Blair, Yu Hui H Chang, Mengru Cheng, Laszlo T Vaszar, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Stanford Ho, Maria Teresa Seville, James M ParishAbstract:In Arizona, USA, Primary Pulmonary Coccidioidomycosis accounts for 15%–29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate Coccidioidomycosis during 2010–2012, we conducted a prospective 24-week study of patients with Primary Pulmonary Coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute Coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.
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the impact of early and brief corticosteroids on the clinical course of Primary Pulmonary Coccidioidomycosis
Journal of Infection, 2013Co-Authors: Natalya Azadeh, Yu Hui H Chang, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Maria Teresa Seville, Janis E BlairAbstract:Summary Objective Primary Pulmonary Coccidioidomycosis can often be associated with hypersensitivity symptoms treatable with a short course of palliative corticosteroids. Long-term use of corticosteroids is a known risk factor for severe or disseminated infection but the effects of short-term use are not known. Methods A retrospective review was conducted of immunocompetent patients with acute Pulmonary Coccidioidomycosis who received systemic corticosteroids for relief of coccidioidal-related symptoms. Age- and sex-matched controls were also reviewed. Predetermined end-points were assessed. Results Seventy-four patients met inclusion criteria for the corticosteroid-treated group, and 74 controls were identified. Cumulative corticosteroid (prednisone-equivalent) doses were 10 mg→3,600 mg (mean = 206 mg; median = 120 mg). Corticosteroids were prescribed most commonly for rash 43/74 [58%] or asthma/wheezing/cough 30/74 [41%]. Coccidioidal-related hospitalization occurred in 19 patients in the corticosteroid group vs. 22 in the control group ( P = .58). Coccidioidal-related symptoms resolved within a mean of 19 weeks (median = 8 weeks [range = 2–208 weeks]) vs. 32.3 weeks (median = 8 weeks [range = 1–1040 weeks]) in the corticosteroid and control groups ( P = .38). Relapse of symptoms occurred in 12% of both groups ( P > .99). ExtraPulmonary dissemination occurred in 3% vs. 4.0% ( P > .99) in the corticosteroid and control groups, respectively. Conclusion This study found no adverse effects of short-term corticosteroid therapy for early symptomatic treatment in acute Pulmonary Coccidioidomycosis.
Holenarasipur R Vikram - One of the best experts on this subject based on the ideXlab platform.
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Coccidioidomycosis in Patients with Selected Solid Organ Cancers: A Case Series and Review of Medical Literature
Mycopathologia, 2016Co-Authors: Colin Fitterer, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Maria Teresa Seville, Zachary Berg, Thorvardur R. Halfdanarson, Janis E BlairAbstract:Coccidioidomycosis is a common infection in the desert southwestern USA; approximately 3 % of healthy persons in Arizona alone become infected annually. Coccidioidomycosis may be severe in immunocompromised persons, but experience among patients with solid organ cancer has not been fully described. Therefore, we aimed to describe the clinical courses of patients whose cancers were complicated by Coccidioidomycosis at our institution, which is located in an area with endemic Coccidioides . To do so, we conducted a retrospective review from January 1, 2000, through December 31, 2014, of all patients with breast, colorectal, or ovarian cancer whose cancer courses were complicated by Coccidioidomycosis. We identified 17,576 cancer patients; 14 (0.08 %) of these patients met criteria for proven or probable Coccidioidomycosis diagnosed within the first 2 years after the cancer diagnosis. All of these patients had Primary Pulmonary Coccidioidomycosis, none had relapsed prior infection, and 1 had possible extraPulmonary dissemination. Five had active coccidioidal infection during chemotherapy, 1 of whom was hospitalized for coccidioidal pneumonia. All were treated with fluconazole, and all improved clinically. Eleven did not require prolonged courses of fluconazole. There were no clearly demonstrated episodes of relapsed infection. In conclusion, Coccidioidomycosis was not a common complication of breast, colorectal, or ovarian cancers in patients treated at our institution, and it was not commonly complicated by severe or disseminated infection.
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serum procalcitonin levels in patients with Primary Pulmonary Coccidioidomycosis
Annals of the American Thoracic Society, 2014Co-Authors: Kenneth K Sakata, Holenarasipur R Vikram, Yu Hui H Chang, Thomas E Grys, Janis E BlairAbstract:Rationale: The serum procalcitonin assay has emerged as a promising biomarker to distinguish between bacterial and viral respiratory tract infections but has not been used to differentiate Coccidioidomycosis from bacterial infection. A correlation between procalcitonin serum levels and Coccidioidomycosis has never been reported.Objective: To determine any association between serum procalcitonin levels and Primary Pulmonary Coccidioidomycosis.Methods: We identified and enrolled 20 immunocompetent patients with symptomatic Primary Pulmonary Coccidioidomycosis of < 8 weeks’ duration and performed a one-time procalcitonin assay, with a cutoff of < 0.25 μg/L indicating a nonbacterial infection.Measurements and Main Results: Nineteen of 20 patients (95%) had serum procalcitonin of < 0.25 μg/L. The median procalcitonin level was 0.05 μg/L (range, < 0.05–0.87 μg/L; interquartile range, 0.05–0.05 μg/L). Sixteen of 20 patients (80%) had undetectable procalcitonin of < 0.05 μg/L. The four patients with detectable pr...
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characteristics of patients with mild to moderate Primary Pulmonary Coccidioidomycosis
Emerging Infectious Diseases, 2014Co-Authors: Janis E Blair, Yu Hui H Chang, Mengru Cheng, Laszlo T Vaszar, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Stanford Ho, Maria Teresa Seville, James M ParishAbstract:In Arizona, USA, Primary Pulmonary Coccidioidomycosis accounts for 15%–29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate Coccidioidomycosis during 2010–2012, we conducted a prospective 24-week study of patients with Primary Pulmonary Coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute Coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.
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the impact of early and brief corticosteroids on the clinical course of Primary Pulmonary Coccidioidomycosis
Journal of Infection, 2013Co-Authors: Natalya Azadeh, Yu Hui H Chang, Holenarasipur R Vikram, Robert Orenstein, Shimon Kusne, Maria Teresa Seville, Janis E BlairAbstract:Summary Objective Primary Pulmonary Coccidioidomycosis can often be associated with hypersensitivity symptoms treatable with a short course of palliative corticosteroids. Long-term use of corticosteroids is a known risk factor for severe or disseminated infection but the effects of short-term use are not known. Methods A retrospective review was conducted of immunocompetent patients with acute Pulmonary Coccidioidomycosis who received systemic corticosteroids for relief of coccidioidal-related symptoms. Age- and sex-matched controls were also reviewed. Predetermined end-points were assessed. Results Seventy-four patients met inclusion criteria for the corticosteroid-treated group, and 74 controls were identified. Cumulative corticosteroid (prednisone-equivalent) doses were 10 mg→3,600 mg (mean = 206 mg; median = 120 mg). Corticosteroids were prescribed most commonly for rash 43/74 [58%] or asthma/wheezing/cough 30/74 [41%]. Coccidioidal-related hospitalization occurred in 19 patients in the corticosteroid group vs. 22 in the control group ( P = .58). Coccidioidal-related symptoms resolved within a mean of 19 weeks (median = 8 weeks [range = 2–208 weeks]) vs. 32.3 weeks (median = 8 weeks [range = 1–1040 weeks]) in the corticosteroid and control groups ( P = .38). Relapse of symptoms occurred in 12% of both groups ( P > .99). ExtraPulmonary dissemination occurred in 3% vs. 4.0% ( P > .99) in the corticosteroid and control groups, respectively. Conclusion This study found no adverse effects of short-term corticosteroid therapy for early symptomatic treatment in acute Pulmonary Coccidioidomycosis.