Hypoxemic Respiratory Failure and Coccidioidomycosis-Associated Acute Respiratory Distress Syndrome

Arash Heidari; Simmer Kaur; Skyler J Pearson; Augustine Munoz; Harleen Sandhu; Gursimran Mann; Michael Schivo; Amir A Zeki; Derek J Bays; Machelle Wilson; Timothy E Albertson; Royce Johnson; George R Thompson

doi:10.1093/ofid/ofad679

Hypoxemic Respiratory Failure and Coccidioidomycosis-Associated Acute Respiratory Distress Syndrome

Open Forum Infect Dis. 2024 Feb 14;11(2):ofad679. doi: 10.1093/ofid/ofad679. eCollection 2024 Feb.

Authors

Arash Heidari^{1

2

3}, Simmer Kaur^{3

4}, Skyler J Pearson⁵, Augustine Munoz^{3

6}, Harleen Sandhu⁴, Gursimran Mann⁵, Michael Schivo⁷, Amir A Zeki⁷, Derek J Bays⁸, Machelle Wilson⁹, Timothy E Albertson⁷, Royce Johnson^{1

3

4}, George R Thompson^{7

10}

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Bakersfield, California, USA.
² Dignity Health, Bakersfield Memorial Hospital, Bakersfield, California, USA.
³ Valley Fever Institute, Bakersfield, California, USA.
⁴ Division of Infectious Diseases, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA.
⁵ University of California-Davis Medical Center, Sacramento, CA, USA.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA.
⁷ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UC Davis Lung Center, University of California Davis Medical Center, Sacramento, CA, USA.
⁸ Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
⁹ Department of Public Health Sciences, University of California- Davis, Davis, California, USA.
¹⁰ Department of Medical Microbiology and Immunology, University of California-Davis Medical Center, Davis, California, USA.

Abstract

Background: Severe coccidioidomycosis presenting with respiratory failure is an uncommon manifestation of disease. Current knowledge of this condition is limited to case reports and small case series.

Methods: A retrospective multicenter review of patients with coccidioidomycosis-associated acute respiratory distress syndrome (CA-ARDS) was conducted. It assessed clinical and laboratory variables at the time of presentation, reviewed the treatment course, and compared this cohort with a national database of patients with noncoccidioidomycosis ARDS. Survivors and nonsurvivors of coccidioidomycosis were also compared to determine prognostic factors.

Results: In this study, CA-ARDS (n = 54) was most common in males, those of Hispanic ethnicity, and those with concurrent diabetes mellitus. As compared with the PETAL network database (Prevention and Early Treatment of Acute Lung Injury; n = 1006), patients with coccidioidomycosis were younger, had fewer comorbid conditions, and were less acidemic. The 90-day mortality was 15.4% for patients with coccidioidomycosis, as opposed to 42.6% (P < .0001) for patients with noncoccidioidomycosis ARDS. Patients with coccidioidomycosis who died, as compared with those who survived, were older, had higher APACHE II scores (Acute Physiology and Chronic Health Evaluation), and did not receive corticosteroid therapy.

Conclusions: CA-ARDS is an uncommon but morbid manifestation of infection. When compared with a national database, the overall mortality appears favorable vs other causes of ARDS. Patients with CA-ARDS had a low overall mortality but required prolonged antifungal therapy. The utility of corticosteroids in this condition remains unconfirmed.

Keywords: ARDS; Coccidioides; fungal pneumonia; glucocorticoids; steroids.

Publication types

Clinical Trial

Abstract

Publication types

Grants and funding