Miliary coccidioidomycosis in the immunocompetent.

Area of Science:

• Infectious Diseases
• Pulmonology
• Mycology

Background:

• Miliary coccidioidomycosis, a disseminated form of Coccidioides immitis infection, typically affects immunocompromised individuals.
• Previous literature suggests a poor prognosis, often leading to respiratory failure in immunocompromised patients.
• This study focuses on the largest series of immunocompetent patients diagnosed with miliary coccidioidomycosis.

Purpose of the Study:

• To describe the clinical characteristics of miliary coccidioidomycosis in immunocompetent patients.
• To outline key diagnostic considerations for this condition.
• To report treatment outcomes and mortality rates in this specific patient group.

Main Methods:

• Retrospective analysis of eight immunocompetent patients diagnosed with miliary coccidioidomycosis between 1990 and 1997.
• Inclusion criteria: diagnosis of miliary coccidioidomycosis, absence of HIV, and confirmation by C. immitis identification.
• Miliary pattern defined radiographically as diffuse 2- to 10-mm lesions in both lung fields.

Main Results:

• Eight immunocompetent patients (23-65 years) were identified, representing 1% of coccidioidomycosis admissions.
• Patients presented with either acute (<1 week) or chronic (5-12 weeks) symptoms.
• Five patients developed acute respiratory distress syndrome (ARDS), and four had meningeal and/or skin involvement; three patients died, all with chronic disease.

Conclusions:

• Miliary coccidioidomycosis in immunocompetent patients can present as acute respiratory illness or advanced chronic disease.
• Outcomes in this series were better than previously reported, with lower mortality.
• Prompt recognition is crucial, aided by travel history, ethnicity, immunologic status, multi-organ involvement, and unexplained hypoxemia.