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• W2013871628 endingPage "175" @default.
• W2013871628 startingPage "149" @default.
• W2013871628 abstract "Coccidioidomycosis is a fungal disease with protean manifestations endemic to the Lower Sonoran Life Zone, which includes the hot deserts of the southwestern United States and areas of Mexico. Two hundred and twenty-three patients were found to have coccidioidomycosis at our institution from 1994-2002, the largest reported cohort of coccidioidomycosis patients since the 1950s. Of these patients, 58% presented with isolated pulmonary disease, 14% had high (>1:16) complement fixation titers without clear evidence of dissemination, 22% had definite disseminated disease, and 5% had unclassified disease. Enzyme immunoassay was a reliable diagnostic tool in those with symptomatic disease, but had a low specificity in those who were asymptomatic. Complement fixation titers of ≥1:16 were associated with dissemination to bone or skin but were not helpful in evaluating central nervous system disease. Thirteen percent of patients with high complement fixation titers (>1:16) without clear evidence of dissemination on presentation and 7% of those with isolated pulmonary disease eventually progressed to disseminated disease; 30% of Filipino patients with pulmonary disease progressed to disseminated disease. Nonwhite race was a predictor for dissemination; African American patients more often developed disseminated bony disease while Filipinos were more likely to develop cutaneous or central nervous system disease. Relapse of disseminated coccidioidomycosis occurred in 24% of patients; the risk was highest (71%) among those with central nervous system disease. Azole therapy was generally inferior to amphotericin B in disseminated disease. Predictors of permanent disability included African American or Filipino race, central nervous system disease, and bony disease. Abbreviations:, CF = complement fixation, CNS = central nervous system, CSF = cerebrospinal fluid, CT = computed tomography, EIA = enzyme immunoassay, LDH = lactate dehydrogenase, MRI = magnetic resonance imaging, OR = odds ratio, VP = ventriculo-peritoneal." @default.
• W2013871628 created "2016-06-24" @default.
• W2013871628 creator A5030110209 @default.
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• W2013871628 creator A5060540112 @default.
• W2013871628 creator A5061821866 @default.
• W2013871628 date "2004-05-01" @default.
• W2013871628 modified "2023-10-14" @default.
• W2013871628 title "Coccidioidomycosis" @default.
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