Pulmonary Computed Tomography Findings of Coccidioidomycosis Infection in Patients with HIV/AIDS: A Retrospective Case Series of 14 Patients in a Vulnerable Population
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the Southwestern United States. Approximately 150,000 cases occur each year but are often subclinical in those with a robust immune system. However, in patients with HIV/AIDS, pulmonary symptoms and complications are far more prevalent. This study aims to elucidate common radiologic findings on Computed Tomography to better characterize trends seen in pulmonary Coccidioidomycosis infection at varying CD4 levels. This will not only assist in characterizing disease progression, but we seek to also provide educational findings that may benefit physicians where Coccidioidomycosis infection may be less prevalent. Methods: A retrospective review of 14 patients with confirmed HIV/AIDS, Coccidioidomycosis infection, and CT scan within 8 weeks of principal diagnosis was performed. Radiologists were blinded to CD4 level. Radiologists evaluated the CT scans for the following findings: nodules, tree-in-bud pattern, alveolar infiltrates, ground glass opacifications, adenopathy, cavitary lesions, pleural effusions, and hypodense splenic lesions. Results: 14/14 cases had a CD4 level less than 200. In total, the frequency of findings was pathologic adenopathy (size >10mm short axis) 57% (8/14), Tree in Bud 100% (14/14), Alveolar Infiltrates 57% (8/14), Nodules 100% (14/14), Pulmonary Cavities 21% (3/14), Ground Glass Opacifications 50% (7/14), Pleural Effusions 29% (4/14), and Splenic Lesions 14% (2/14). Adenopathy was present only in cases with CD4 levels below 100 at a prevalence of 80% (8/10). Alveolar infiltrates were present at all CD4 ranges. Ground glass opacification was present only in cases with CD4 levels below 50 with a prevalence of 88% (7/8). Pulmonary cavities were present only in cases with CD4 levels below 50 with a prevalence of 38% (3/8). Conclusion: Patient sample size significantly limited statistical analysis with no statistical significance proven. Despite this, we may begin to appreciate the severity of disease burden. Findings such as ground glass opacification and pulmonary cavities become more frequent as CD4 levels continue to fall. While not unexpected with increasing immunosuppression, these images serve as a leading point for further exploration where prior imaging was limited and provide an educational benefit through varying imaging findings within a vulnerable population.