Coccidioides species are thermally dimorphic fungi found in geographically defined areas of the Western Hemisphere. The primary portal of entry is respiratory, with symptomatic pneumonic diseases as the most common presentation. Subsequent pulmonary complications as well as extrapulmonary metastatic infection may occur, either of which may be the presenting disease manifestation. Cavitary lung disease may be found incidentally or when investigating symptoms such as cough or hemoptysis. This study aims to explore the spectrum of coccidioidal cavities and the evaluation and management in a cohort of patients seen at Kern Medical over the last 12 years.

Coccidioides spp are thermally dimorphic fungi found in geographically defined areas of the Western Hemisphere. The primary portal of entry is respiratory, with a symptomatic pneumonic disease as the most common presentation. Subsequent pulmonary complications as well as extrapulmonary metastatic infection may occur, either of which may be the presenting disease manifestation. Cavitary lung disease may be found incidentally or when investigating symptoms such as cough or hemoptysis. This study aims to explore the spectrum of coccidioidal cavities and the evaluation and management in a cohort of patients seen at Kern Medical over the last 12 years.

Coccidioidal pulmonary cavitation remains a complex disease to evaluate and treat. This study's ethnic demographic differed from other cohorts. It also contradicts the notion that pulmonary coccidioidal cavitary disease and dissemination infrequently manifest in the same patient. In the present age of triazole therapy, indications and the need for surgery continue to decline. Further investigation needs to be conducted to evaluate medical therapy’s efficacy and long-term outcomes. Rupam Sharma, PGY-1/MD, Astellas: Grant/Research Support George R. Thompson, III, MD, Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Mayne: Advisor/Consultant|Mayne: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support

While a majority of Coccidioides infections are asymptomatic, it is estimated that 1% develop severe disease and can be fatal. Prior retrospective reviews that attempt to identify risk factors for fatal disease have been limited to public health data hampered by reporting challenges and accuracies. Morbidity review of fatal cases identified by clinical criteria rather than ICD-9/ICD-10 reporting may improve accuracy of conclusions. At an academic center in an endemic area, medical records from three sequential electronic medical record systems were reviewed from approximately January 2000 to January 2023. Patients with coccidioidomycosis were identified by microbiological, pathological, serological, or skin testing criteria. Deaths were determined by in hospital records, insurance reporting, review of death certificate if available, or public record. Demographics, clinical course, outcomes and causes of death are compared. Incomplete medical records to make comparison were excluded. Retrospective root cause analysis was performed. To date, at least 50 patients met clinical criteria for having coccidioidomycosis at one point in their life and died. ICD coding was wrong in about half of the cases. Data integrity has been a challenge when extracting data across three electronic medical record systems. New risk factors found by root cause analysis not previously identified. Patients were found to have died either with coccidioidomycosis or from coccidioidomycosis. ICD coding was inconsistent. Precise and accurate description of coccidioidomycosis staging is important when trying to determine risk factors for fatal disease. All Authors: No reported disclosures

Coccidioides spp is a soil-dwelling, dimorphic fungus that causes coccidioidomycosis. It is endemic to the western hemisphere. Although primarily a respiratory disease, it can also cause a myriad of clinical manifestations, from asymptomatic disease to meningitis. In fact, Coccidioides species is probably the most common etiologic agent of long-term meningitis in California and Arizona. Early diagnosis and treatment are critical to avoid fatal complications. With treatment, the cerebral spinal fluid analysis may return to normal. Relapse of coccidioidal meningitis is usually suspected with recurrence of meningitis symptoms. The patient is a 53-year-old man with a 2-decade history of coccidioidal meningitis who was diagnosed with an asymptomatic relapse of coccidioidal meningitis.