Residual cavities in pulmonary coccidioidomycosis; follow-up studies.

In an article published elsewhere’ we reported observations on 20 cases of residual lesions of pulmonary coccidioidomycosis in veterans of World War II now residing in New York City. Thirteen cases were described in detail. Twelve were of the form known as the initial or primary infection, and one was the progressive or disseminated (coccidioldal granuloma) form of infection. The need for a careful distinction between these two forms has been stressed most recently by Smith, Beard and Saito.2 The primary form of infection follows the inhalation of the chlamydospores of the fungus coccidioldes immitis, and results in self-limited, usually benign, pulmonary lesions. The disseminated form of infection, which is relatively rare, arises from lymphohematogenous spread of the primary Infection, and it is fatal in up to 50 per cent of the cases. The high incidence,3 (estimated 25 per cent), of coccidloidal infection in military personnel who were exposed in the Southwest desert endemic area is reflected In the veterans now coming under medical observation. A significant number of cases of residual pulmonary lesions have been encountered. A series of cases with coccidioldal pulmonary cavitation has been studied. The four representative case reports which follow are limited to patients with pulmonary cavities, residuals of the primary infection. Emphasis is placed on the residual cavity, as distinguished from residual nodular densities, because of the Importance of its differentiation from other pulmonary conditions, particularly tuberculosis. From five to seven years have elapsed since these patients were exposed in the Southwest endemic area. They are generally asymptomatic and the roentgenographlc appearance shows little or no change during the period of observation. The question of therapy, which has recently been mentioned prominently In the literature,2’4 will be discussed following the case reports.