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Acute coccidioidal pleural effusion

S A Lonky, A Catanzaro, K M Moser

    The American Review of Respiratory Disease
    |October 1, 1976
    PubMed
    Summary
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    Acute coccidioidal pleural effusions are typically secondary to direct infection spread, not dissemination. Most patients have an excellent prognosis, suggesting expectant therapy even with rising titers.

    Area of Science:

    • Infectious Diseases
    • Pulmonology
    • Mycology

    Background:

    • Coccidioidal pleural effusion is a rare but serious manifestation of Coccidioides infection.
    • Understanding the pathogenesis and prognosis is crucial for appropriate patient management.

    Purpose of the Study:

    • To investigate the characteristics and outcomes of acute coccidioidal pleural effusions.
    • To determine the primary route of infection and optimal therapeutic strategies.

    Main Methods:

    • Retrospective analysis of 28 patients with acute coccidioidal pleural effusions.
    • Review of clinical data, diagnostic methods, and treatment outcomes.
    • Analysis of cultures from pleural biopsy specimens and serological markers.

    Main Results:

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    • Over 90% of effusions resulted from direct spread of contiguous parenchymal infection.
    • Disseminated infection occurred in only 2 patients with predisposing factors.
    • Pleural biopsy cultures were highly sensitive (100% positive in 8 patients).
    • Dermal hypersensitivity reactions were common in uncomplicated cases.

    Conclusions:

    • Coccidioidal pleural effusion is primarily due to direct spread, with a generally excellent prognosis.
    • Expectant therapy is recommended, even with rising complement fixation titers.
    • Pleural biopsy is a valuable diagnostic tool.