PURPOSE:Coccidioidomycosis is a common fungal infection prevalent in the southwestern United States. Disease manifestations range from flu-like episodes to severe life-threatening disease. There is limited data on clinical and laboratory features that may predict ICU admission.
METHODS:A retrospective chart analysis of patients admitted to UCSF Fresno teaching hospitals with confirmed cases of coccidioidomycosis based on serology, pathology and/or culture were included. Clinical and laboratory data at the time of admission was collected and multi-logistic regression analysis was used to determine significant predictive factors for ICU admission.
RESULTS:A total of 179 patients were hospitalized for Coccidioidomycosis from January 2000 to December 2007. The admission rates were significantly higher in the years 2005 and 2006 (P<0.001).The mean age (years ± sem) of male (n=144) was 42.3 ±1.1 and female (n=35) was 44.3 ± 2.7. The ethnic distribution was Asian 9 (5%), African American 25 (14%), Caucasian 35 (20%) and Hispanic 111 (60%). The site of involvement was pulmonary in 100 (56%), meningitis 38 (21%) and other sites in 41 (23%). Of 179 patients, 58 (32%) were admitted to the ICU. The mortality in this cohort was 18%. Multi-logistic regression analysis showed that significant predictors were ethnicity, presence of meningitis, leukocytosis and azotemia.
CONCLUSION:The overall mortality in hospitalized patients with Coccidioidomycosis was 18%. Factors predictive of ICU admission were the ethnicity, presence of meningitis, leukocytosis and azotemia. Compared to Hispanics, African Americans, Caucasians and Asians were at higher risk of developing severe disease requiring ICU care. A significant increase in hospitalization during 2005 and 2006 requires further investigation.
CLINICAL IMPLICATIONS:Hispanic race may have protective effect against severe coccidioidomycosis, compared to Asians, African Americans and Caucasians.
DISCLOSURE:Arthur Romero, No Financial Disclosure Information; No Product/Research Disclosure Information