What is the role of surgery in the treatment of chronic progressive pneumonia in 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

Surgical indications include the following:

  • Persistent or massive hemoptysis

  • Enlarging pulmonary cavities (>5 cm) adjacent to the visceral pleural with high risk of rupture

  • Spontaneous pneumothorax with persistent lung collapse

  • Empyema drainage not amenable to chest tube drainage

  • Bronchopleural fistula closure

  • Expansion of lungs restricted by residual pleural disease

  • Symptomatic fungus ball

Limitations to surgical treatment include the following:

  • High complication rate with closure of bronchopleural fistula (30%)

  • Recurrent disease (cavitation) in 18%

  • Reduced postoperative risk seen with preoperative amphotericin B therapy, but experience with azole therapy is unknown


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