How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2024-12-13 DOI:10.1016/j.chest.2024.12.001
Fariba M Donovan, George R Thompson, Janis E Blair, Royce H Johnson, Josh Malo, Waseem Albasha, Stephanie G Worrell, Staci E Beamer, Kavitha Yaddanapudi, John N Galgiani, Neil M Ampel
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Abstract

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides spp. and increased international travel to endemic regions. The majority of individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will develop primary pulmonary coccidioidomycosis (PCM) with signs and symptoms that mimic community acquired pneumonia (CAP) or other respiratory illnesses. Further, 5% of those diagnosed will develop serious and even life-threatening manifestations including extrapulmonary/disseminated coccidioidomycosis (DCM). Of those who develop PCM, past evidence suggests ∼ 5% to 15% will develop long-term pulmonary sequelae in the form of nodules, abscesses, or cavitary lesions. These lesions may not be easily distinguished from malignancy or other infections, such as tuberculosis, and they add a substantial burden to both patients and the healthcare system. Despite the long-term consequences of cavitary CM in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report we will focus on cavitary lesions in CM with the goal to present a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.

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球孢子菌病(CM)是由二形真菌隐球孢子菌(C. immitis)和正球孢子菌(C. posadasii)引起的,在国内和世界范围内都被认为是一种日益严重的威胁。这在很大程度上是由于球孢子菌属的分布范围不断扩大,以及前往流行地区的国际旅行增多。接触到空气中球孢子菌的大多数人不需要就医,但约有 30% 的人会患上原发性肺球孢子菌病 (PCM),其体征和症状与社区获得性肺炎 (CAP) 或其他呼吸道疾病相似。此外,5% 的确诊患者会出现严重甚至危及生命的表现,包括肺外/散播性球孢子菌病 (DCM)。过去的证据表明,在罹患球孢子菌病的患者中,有 5%至 15%的人会出现结节、脓肿或空洞性病变等长期肺部后遗症。这些病变可能不易与恶性肿瘤或其他感染(如肺结核)区分开来,给患者和医疗系统都带来了沉重的负担。尽管腔隙性中耳炎会对某些患者造成长期影响,但目前的文献综述和实践指南显示,治疗这些患者的明确管理策略并不多见。在本报告中,我们将重点讨论腔隙性 CM 病变,旨在介绍对其各种形式、表现和并发症的评估和管理。这些建议来自一个多学科专家小组。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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