Surgery for Pulmonary Coccidioidomycosis: A 10-Year Experience

Dawn E. Jaroszewski, Wissam J. Halabi, Janis E. Blair, Brandon J. Coakley, Raymond K. Wong, James M. Parish, Laszlo T. Vaszar, Shimon Kusne, Holenarasipur R. Vikram, Paterick A. DeValeria, Louis A. Lanza, Francisco A. Arabia

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background: Coccidioidomycosis results from infection with Coccidioides species endemic to the southwestern United States. The mobile US population has resulted in incremental cases being found throughout the world. The fungal infection can result in pulmonary sequelae, including nodules, cavities, and complications requiring treatment by the thoracic surgeon. Methods: A retrospective chart review was conducted of 1,496 patients with coccidioidomycosis treated at our institution (January 1998 to December 2008) to identify those requiring surgery. Results: Of the 1,496 patients, 86 (6%; mean age, 58 years [range, 18 to 81], 48 women) underwent operations. Radiographs revealed 59 nodules, 18 cavities, 2 infiltrates, and 7 complications of disease (e.g., effusion, pneumothorax, and empyema). Of the 86 patients, 40% underwent resection for persistent symptoms or disease progression despite adequate antifungal therapy. One third of the operations were performed by video-assisted thoracoscopic surgery. Morbidity, 21% (18 patients), and in-hospital mortality, 2% (2 patients), were greater after resection for cavitary lesions with resultant complications versus for nodular disease: 41% versus 12% (p ≤ 0.002) and 8% versus 0% (p < 0.005). Prolonged air leaks or bronchopleural fistulas were the most common complications (13 patients). Postoperative antifungal therapy was administered to 42% of patients (89% of cavitary and complicated). There were no cases of recurrence at follow-up (mean, 24 months). Conclusions: Surgical intervention was indicated for only a few patients, most commonly for diagnostic dilemmas involving nodular disease, symptomatic nonresponsive cavitary disease, or complications. Prolonged air leaks were the main cause of morbidity. Resection should result in symptom resolution and long-term freedom from recurrence.

Original languageEnglish (US)
Pages (from-to)1765-1772
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Dec 2009

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Surgery for Pulmonary Coccidioidomycosis: A 10-Year Experience'. Together they form a unique fingerprint.

Cite this