The impact of early and brief corticosteroids on the clinical course of primary pulmonary coccidioidomycosis.

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 10 mg → 3,600 mg (mean = 206 mg; median = 120 mg). 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.

• Authors: Natalya Azadeh, Yu-Hui H Chang, Shimon Kusne, Holenarasipur R Vikram, Maria T Seville, Robert Orenstein, Janis E Blair
• Journal: The Journal of infection (J Infect) Vol. 67 Issue 2 Pg. 148-55 (Aug 2013) ISSN: 1532-2742 [Electronic] England
• PMID: 23570823 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents

Topics

• Adolescent
• Adrenal Cortex Hormones (administration & dosage, adverse effects)
• Adult
• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents (administration & dosage, adverse effects)
• Coccidioidomycosis (drug therapy, pathology)
• Drug-Related Side Effects and Adverse Reactions (epidemiology)
• Female
• Humans
• Lung Diseases, Fungal (drug therapy, pathology)
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult