Pleural effusion in hospitalized patients with Coccidioidomycosis

Coccidioidomycosis is a common fungal infection primarily affecting the lungs. The prevalence and the characteristics of pleural effusion in Coccidioidomycosis are not well described. Therefore, a retrospective analysis of data from patients admitted to a teaching hospital with a diagnosis of Coccidioidomycosis and pleural effusion was done.

All patients admitted with a diagnosis of Coccidioidomycosis were identified using ICD 9 from 114 to 114.9 from computerized medical records. Epidemiological, clinical and laboratory data were transcribed from medical records of all inpatients. Pleural effusion was identified using reports of chest radiography, ultrasound and CT scan of chest.

Pleural effusion occurred in 22 of 146 (15%) patients hospitalized for Coccidioidomycosis. The proportion of patients with pleuritic chest pain, cough and dyspnea were significantly higher in patients with effusion than without effusion (p<0.01). There was a tendency for pleural effusions to occur more often on the left side (p=0.064). Empyema occurred in 22.7% of pleural effusions. Pleural fluid chemistry showed that all effusions were exudates with a mean (+/-S.E.M.) pleural fluid eosinophil count of 10.3+/-4.65.

Pleural effusions are common in hospitalized patients with Coccidioidomycosis. Pleural fluid eosinophilia should alert clinician to Coccidioides immitis as a possible etiological agent especially in an endemic area. Empyema occurred in a quarter of pleural effusions and resolution required thoracotomy.