Malnutrition and fatigue in coccidioidomycosis: Measurement and mechanisms
AuthorBowers, Jennifer M.
KeywordsHealth Sciences, Nutrition.
AdvisorHowell, Wanda H.
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractCoccidioidomycosis is a fungal infection resulting from the inhalation of spores from the soil-borne organism, Coccidioides immitis . Historical and contemporary literature cite weight loss and fatigue in patients, but these clinical symptoms have not been quantified. The first goal of this study was to describe nutritional changes throughout the infection course utilizing longitudinal data from 117 patients from the Southern Arizona VA Healthcare System. Subjects were categorized into groups according to weight and visceral protein status. The level of nutritional deficit was associated with the severity and duration of infection. Although patients varied greatly, as reductions in body mass index (BMI) and percent ideal body weight occurred, infection severity worsened. Serum prealbumin and weight loss were positively correlated with clinical score. The second goal was to quantify coccidioidomycosis-related fatigue to document severity. The Fatigue Severity Scale (FSS) was utilized to measure the fatigue experienced by 48 coccidioidomycosis patients and 20 healthy controls. A mean FSS score of 4.796 ± 1.91 was found in patients, indicative of severe fatigue. Compared to healthy controls, patients are significantly more fatigued (p < 0.0001). This severe fatigue is not related to infection duration, severity or patient demographics, however as weight declines, fatigue worsens. The third goal was to ascertain potential cytokine-related mechanisms associated with weight loss or fatigue manifested in coccidioidomycosis. Samples of serum, control blood, and blood incubated with coccidioidal antigen were analyzed for levels of TNF-alpha and leptin were via enzyme-linked immunosorbent assay (ELISA). Cytometric bead array via flow cytometry was utilized to measure TNF-α, IFN-γ, IL-2, IL-4, IL-5 and IL-10 values in blood incubated with antigen. Results were related to weight status (BMI) and fatigue severity (FSS score). A possible relationship between leptin and fatigue in blood incubated with antigen occurred. Serum leptin and leptin in blood incubated with antigen were positively related to BMI. In blood incubated with antigen, TNF-α, IFN-γ and IL-2 levels were positively related to BMI.
Degree ProgramGraduate College