The impact of early and brief corticosteroids ontheclinical course of primary pulmonary coccidioidomycosis

Natalya Azadeh, Yu Hui H. Chang, Shimon Kusne, Holenarasipur R. Vikram, Maria T. Seville, Robert Orenstein, Janis E. Blair

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: Primary pulmonary coccidioidomycosis can often be associated with hypersensitivity symptoms treatable with a short course of palliative corticosteroids. Long-term use of corticosteroids is a known risk factor for severe or disseminated infection but the effects of short-term use are not known. Methods: A retrospective review was conducted of immunocompetent patients with acute pulmonary coccidioidomycosis who received systemic corticosteroids for relief of coccidioidal-related symptoms. Age- and sex-matched controls were also reviewed. Predetermined end-points were assessed. Results: Seventy-four patients met inclusion criteria for the corticosteroid-treated group, and 74 controls were identified. Cumulative corticosteroid (prednisone-equivalent) doses were 10mg→3,600mg (mean=206mg; median=120mg). Corticosteroids were prescribed most commonly for rash 43/74 [58%] or asthma/wheezing/cough 30/74 [41%]. Coccidioidal-related hospitalization occurred in 19 patients in the corticosteroid group vs. 22 in the control group (P=58). Coccidioidal-related symptoms resolved within a mean of 19 weeks (median=8 weeks [range=2-208 weeks]) vs. 32.3 weeks (median=8 weeks [range=1-1040 weeks]) in the corticosteroid and control groups (P=38). Relapse of symptoms occurred in 12% of both groups (. P>.99). Extrapulmonary dissemination occurred in 3% vs. 4.0% (. P>.99) in the corticosteroid and control groups, respectively. Conclusion: This study found no adverse effects of short-term corticosteroid therapy for early symptomatic treatment in acute pulmonary coccidioidomycosis.

Original languageEnglish (US)
Pages (from-to)148-155
Number of pages8
JournalJournal of Infection
Volume67
Issue number2
DOIs
StatePublished - Aug 1 2013

Keywords

  • Coccidioidomycosis
  • Corticosteroid
  • Dissemination
  • Prognosis
  • Steroids

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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