Coccidioidomycosis in elderly persons.

Area of Science:

• Mycology
• Infectious Diseases
• Epidemiology

Background:

• Coccidioidomycosis is a fungal infection endemic to the southwestern US and Mexico, acquired through inhaling Coccidioides arthrospores.
• Recent trends show increasing incidence in endemic areas, with higher rates observed in older populations in Arizona.

Purpose of the Study:

• To compare clinical manifestations of coccidioidomycosis in patients aged 60 years and older versus those younger than 60.
• To identify factors influencing disease severity and outcomes in different age groups.

Main Methods:

• Retrospective data review of patients treated for coccidioidomycosis at an institution.
• Comparison of clinical presentations between two age cohorts: >=60 years and <60 years.
• Statistical analysis, including logistic regression, to assess the impact of age, immunosuppression, and comorbidities on disease outcomes.

Main Results:

• No significant differences in coccidioidomycosis manifestations were found between age groups when controlling for comorbidities (excluding immunosuppression).
• Immunosuppressed patients, regardless of age, had significantly higher rates of extrapulmonary dissemination, hospitalization, progressive infection, and mortality.
• Immunosuppression was identified as the sole significant risk factor for extrapulmonary dissemination, hospitalization, and death.

Conclusions:

• Coccidioidomycosis is a severe illness across all patient demographics.
• The increased severity of coccidioidomycosis in older individuals appears primarily associated with immunosuppression rather than age alone.
• Management strategies should consider immunosuppression status as a critical factor for predicting coccidioidomycosis outcomes.