Approximately 5 to 15% of patients with pulmonary coccidioidomycosis subsequently develop pulmonary cavities. These cavities may resolve spontaneously over a number of years; however, some cavities never close, and a small proportion causes complications such as hemorrhage, pneumothorax or empyema. The impact of azole antifungal treatment on coccidioidal cavities has not been studied. Because azoles are a common treatment for symptomatic pulmonary coccidioidomycosis, we aimed to assess the impact of azole therapy on cavity closure. From January 1, 2004, through December 31, 2014, we retrospectively identified 313 patients with cavitary coccidioidomycosis and excluded 42 who had the cavity removed surgically, leaving 271 data sets available for study. Of the 271 patients, 221 (81.5%) received azole therapy during 5-year follow-up; 50 patients did not receive antifungal treatment. Among the 271 patients, cavities closed in 38 (14.0%). Statistical modeling showed that cavities were more likely to close in patients in the treated group than in the nontreated group (hazard ratio, 2.14 [95% CI: 1.45-5.66]). Cavities were less likely to close in active smokers than nonsmokers (11/41 [26.8%] vs 97/182 [53.3%]; P = 0.002) or in persons with than without diabetes (27/74 [36.5%] vs 81/149 [54.4%]; P = 0.01).We did not find an association between cavity size and closure. Our findings provide rationale for further study of treatment protocols in this subset of patients with coccidioidomycosis. LAY SUMMARY Coccidioidomycosis, known as valley fever, is a fungal infection that infrequently causes cavities to form in the lungs, which potentially results in long-term lung symptoms. We learned that cavities closed more often in persons who received antifungal drugs, but most cavities never closed completely.

中文翻译：

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球虫球菌病：唑类抗真菌治疗的影响。

约有5％至15％的肺球虫病患者随后会出现肺腔。这些蛀牙可能会在数年内自发消退。但是，有些腔孔永远不会闭合，很小的腔孔会引起并发症，例如出血，气胸或脓胸。尚未研究吡咯类抗真菌剂治疗对球孢子腔的影响。由于唑类药物是有症状肺球虫病的一种常见治疗方法，因此我们旨在评估唑类药物治疗对腔闭的影响。从2004年1月1日至2014年12月31日，我们回顾性鉴定了313例球状球虫病患者，并排除了42例通过手术切除腔的患者，剩下271个数据可供研究。在271名患者中，有221名（81.5％）在5年的随访期间接受了唑类治疗；50例患者未接受抗真菌治疗。在271例患者中，有38例（14.0％）出现了空洞。统计模型表明，与未治疗组相比，治疗组患者更容易闭合腔体（危险比为2.14 [95％CI：1.45-5.66]）。与不吸烟者相比，经常吸烟者与不吸烟者相比，不吸烟者闭腔的可能性较小（11/41 [26.8％] vs 97/182 [53.3％]； P = 0.002）。 149 [54.4％]； P = 0.01）。我们没有发现腔体尺寸与闭合度之间存在关联。我们的发现为进一步研究球孢子菌病患者亚组的治疗方案提供了依据。概述球孢子菌病，被称为谷热，是一种真菌感染，很少会在肺中形成空腔，这有可能导致长期的肺部症状。