What is the morbidity and mortality associated with coccidioidomycosis?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Although morbidity is substantial in coccidioidomycosis, mortality is very low; the mortality rate is approximately 0.07%. Death occurs most commonly in patients with disseminated disease, underlying risk factors, or immunosuppression. In immunocompromised patients, mortality can be as high as 70% even with appropriate therapy. [2, 3, 4] Few patients with advanced HIV infection who develop Coccidioides infection have survived longer than a few months.

In disseminated disease, the mortality rates in neonates and infants are much higher than those seen in children, adolescents, and adults. Septic shock may develop, especially in older or immunocompromised patients, and unfortunately, the outcome in these patients is uniformly poor.

Of the clinical syndromes, mortality is highest in coccidioidal meningitis. If left untreated, meningitis is fatal in 90% of patients within 1 year and is universally fatal within 2 years. Mortality rates can be 20-40%, even with treatment.

Mortality is significantly increased in coccidioidal meningitis patients with complications such as hydrocephalus or infectious arteritis. Hydrocephalus is the most common complication (30%) and carries a mortality rate of 40%. Occlusion of the cranial vessels by inflammatory exudates may lead to stroke. Occlusion occurs in 10% of patients and increases the likelihood of mortality. [37]


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