386. A Reexamination of Disseminated Coccidioidomycosis: The Natural History in the Pre-Antifungal Era

Abstract

BackgroundWhile it has been previously well described that central nervous system (CNS) coccidioidomycosis (CM) is nearly always fatal without treatment, the natural history of non-CNS disseminated coccidioidomycosis (DCM) infections is not well characterized. The historical VA-Armed forces CM patient group provides a unique cohort of patients not treated with standard antifungals to characterize the natural history of non-CNS DCM.MethodsWe conducted a retrospective study of 595 VA-Armed forces CM patients diagnosed between 1955 and 1958 and followed to 1966. Cohorts were identified as non-disseminated disease (487 patients), non-CNS DCM (72 patients), and CNS DCM (36). A combination of statistical analyses were used to compare demographic information, laboratory data including serologies and complete blood count data, symptom severity, fate of primary infection, and mortality.ResultsThere were significant differences in the ethnicity between the cohorts with trends toward increased Black and Filipino patients in the disseminated cohorts (P < 0.001). There was a trend showing increased frequency of leukocytosis regardless of eosinophilia in the disseminated cohorts (P = 0.009). Patients with disseminated disease presented with more severe symptoms (P = 0.006). Primary fate of infection demonstrated decreased rates of residual pulmonary nodule in DCMs: 38.19% in non-DCM, 13.89% in non-CNS DCM, and 19.44% in CNS DCM (P < 0.001). In addition, there were decreased rates of residual cavities in DCM: 33.26% in non-DCM, 8.33% in non-CNS DCM, and 8.33% in CNS DCM (P < 0.001). Forty-five percent and 53% of patients in the non-CNS DCM and CNS DCM cohorts, respectively, developed dissemination with initial infection. Mortality at last known follow-up due to CM was significantly different across the cohorts: 1.03% in non-DCM, 15.28% in non-CNS DCM, and 77.78% in CNS DCM (P < 0.001).ConclusionThis large retrospective cohort study helps further characterize the natural history of non-CNS DCM in comparison to CNS DCM in a population that was not treated with conventional antifungal therapy. While not as fatal as CNS DCM, non-CNS DCM shares many characteristics and has a high associated morbidity.Disclosures All authors: No reported disclosures.