Coccidioidomycosis-associated Deaths, United States, 1990–2008

Huang, J.; Bristow, Benjamin; Shafir, Shira; Sorvillo, Frank

doi:10.3201/eid1811.120752

Cited by 73 publications

(54 citation statements)

References 27 publications

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“…In comparison to other studies, we reviewed exclusively NSCLC patients, whereas other studies included many different malignancies. Furthermore, our study was conducted in a region with high levels of endemic coccidioidomycosis and a high prevalence of benign nodules (17). Taken together, our data are consistent with the previously described reports and confirm the finding that WB-PET/CT is inferior to BH-CT for detection of pulmonary nodules.…”

Section: Discussionsupporting

confidence: 92%

Detecting Pulmonary Nodules in Lung Cancer Patients Using Whole Body FDG PET/CT, High-resolution Lung Reformat of FDG PET/CT, or Diagnostic Breath Hold Chest CT

et al. 2016

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Rationale and Objectives: Pulmonary nodules can be missed on the non-breath hold computed tomography (CT) portion of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and for this reason prior studies have advocated for routinely performing dedicated breath hold CT of the chest in addition to PET/CT for routine staging of malignancy. We evaluated the rate of pulmonary nodule detection on standard CT images from whole body PET/CT studies (WB-PET/CT), high-resolution lung reconstruction CT images from PET/CT studies (HR-PET/CT), and diagnostic breath hold chest CT (BH-CT). Materials and Methods:A cohort of 25 patients was identified who had a history of lung cancer as well as a PET/CT staging or restaging scan and BH-CT within 30 days of each other. All PET/CTs included a set of CT images using a soft tissue algorithm filter and 3.75-to 5-mm slice thickness, as well as high-resolution reformats with a sharp reconstruction filter and 2-mm slice thickness. The CT images from WB-PET/CT, HR-PET/CT, and BH-CT were reviewed by three radiologists. Significance was analyzed by two-way repeated measures analysis of variance.Results: There were 2.84 nodules found per patient with WB-PET/CT, 3.85 nodules with HR-PET/CT, and 3.91 nodules with BH-CT. When only nodules less than or equal to 8 mm in size were considered, WB-PET/CT also demonstrated significantly fewer nodules (1.98) compared to the HR-PET/CT (2.94) or a BH-CT (2.86) (P < 0.001). No difference in detection rate was noted between the two higher resolution modalities.Conclusions: More pulmonary nodules are detected on the CT portion of PET/CT studies when high-resolution reformatted images are created and reviewed. The ability to detect nodules with the reformatted images was indistinguishable from dedicated BH-CT. Overall, high-resolution reformats of PET/CT images of the lungs can increase the sensitivity for pulmonary nodule detection, approaching that of dedicated BH-CT. These data suggest that if HR-PET/CT reformats are used, additional dedicated BH-CT is unnecessary for routine staging of lung cancer.

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Section: Discussionsupporting

confidence: 92%

Detecting Pulmonary Nodules in Lung Cancer Patients Using Whole Body FDG PET/CT, High-resolution Lung Reformat of FDG PET/CT, or Diagnostic Breath Hold Chest CT

et al. 2016

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“…Based on death certificate data, the mortality rate in Arizona actually decreased slightly from 0.9/100,000 in 1996 to 0.5/100,000 in 2005 61. A review of US death certificates identified a total of 3089 coccidioidomycosis-associated deaths during 1990–2008, but found that mortality rates have remained fairly stable since 1997, with an overall age-adjusted mortality rate of 0.59 per 1 million person-years during the study period 122. Possible reasons for the stable mortality rates despite the overall increase in incidence include treatment advancements or a disproportionate increase in primary pulmonary coccidioidomycosis diagnoses compared to the more severe forms of disease 61.…”

Section: Risk Factors For Infectionmentioning

confidence: 99%

Coccidioidomycosis: epidemiology

Thompson¹,

Brown²,

Benedict³

et al. 2013

CLEP

140

106

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Coccidioidomycosis consists of a spectrum of disease, ranging from a mild, self-limited, febrile illness to severe, life-threatening infection. It is caused by the soil-dwelling fungi, Coccidioides immitis and C. posadasii, which are present in diverse endemic areas. Climate changes and environmental factors affect the Coccidioides lifecycle and influence infection rates. The incidence of coccidioidomycosis has risen substantially over the past two decades. The vast majority of Coccidioides infections occur in the endemic zones, such as California, Arizona, Mexico, and Central America. Infections occurring outside those zones appear to be increasingly common, and pose unique clinical and public health challenges. It has long been known that elderly persons, pregnant women, and members of certain ethnic groups are at risk for severe or disseminated coccidioidomycosis. In recent years, it has become evident that persons with immunodeficiency diseases, diabetics, transplant recipients, and prisoners are also particularly vulnerable.

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“…We investigate the performance of PET/CT in subjects from Northern California where there is highly endemic granulomatous disease (coccidioidomycosis) [10]. Unlike several prior series investigating the use of PET/CT, all diagnoses were confirmed by histopathology.…”

Section: Introductionmentioning

confidence: 99%

FDG PET/CT evaluation of pathologically proven pulmonary lesions in an area of high endemic granulomatous disease

2013

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PurposeThe goal of this study is to assess how reliable the threshold maximum standardized uptake value (maxSUV) of 2.5 on positron emission tomography–computed tomography (PET/CT) is for evaluation of solitary pulmonary lesions in an area of endemic granulomatous disease and to consider other imaging findings that may increase the accuracy of PET/CT.Materials and methodsThe staging PET/CT of 72 subjects with solitary pulmonary lesions (nodules (less than 3 cm) or masses (greater than 3 cm)) were retrospectively reviewed. Pathology proven diagnosis from tissue samples was used as the gold standard. Logistic regression was used to assess whether the subject’s age, maxSUV, size of lesion, presence of emphysema, or evidence of granulomatous disease was predictive of malignancy.ResultsMalignant lesions were identified in 84.7 % (61/72) of the 72 subjects. A threshold maxSUV of 2.5 had a sensitivity of 95.1 % (58/61), specificity of 45.5 % (5/11), positive predictive value of 90.6 % (58/64), negative predictive value of 62.5 % (5/8) and an accuracy of 87.5 % (63/72). The false negative rate was 4.9 %, and the false positive rate was 54.5 %. All 3 false negatives were less than or equal to 1.0 cm; however, false positives ranged from 1.1 to 5.6 cm. The false negatives had a mean (SD) maxSUV of 2.0 (0.4), whereas the false positives had a mean (SD) maxSUV of 5.6 (3.0). Emphysema was associated with 1.1 higher odds of malignancy, and evidence of granulomatous disease was associated with 0.34 lower odds of benign disease, however, neither was statistically significant (p = 0.92 and p = 0.31, respectively). Higher maxSUV was significantly associated with increased risk of malignancy (p = 8.3 × 10−3). Older age and larger size of lesion were borderline associated with increased risk of malignancy (p = 0.05 and p = 0.07, respectively).ConclusionIn an area of high endemic granulomatous disease, the PET/CT threshold maxSUV of 2.5 retains a high sensitivity (95.1 %) and positive predictive value (90.6 %) for differentiating benign from malignant pulmonary lesions; however, the specificity (45.5) and negative predictive value (62.5) decrease due to increased false positives. The presence of emphysema and absence of evidence of granulomatous disease increases the probability that a pulmonary lesion is malignant; however, these were not statistically significant.

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Coccidioidomycosis-associated Deaths, United States, 1990–2008

Cited by 73 publications

References 27 publications

Detecting Pulmonary Nodules in Lung Cancer Patients Using Whole Body FDG PET/CT, High-resolution Lung Reformat of FDG PET/CT, or Diagnostic Breath Hold Chest CT

Detecting Pulmonary Nodules in Lung Cancer Patients Using Whole Body FDG PET/CT, High-resolution Lung Reformat of FDG PET/CT, or Diagnostic Breath Hold Chest CT

Coccidioidomycosis: epidemiology

FDG PET/CT evaluation of pathologically proven pulmonary lesions in an area of high endemic granulomatous disease

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