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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空洞球孢子菌病：唑类抗真菌治疗的影响

大约 5% 到 15% 的肺球孢子菌病患者随后会出现肺空洞。这些蛀牙可能会在数年内自发消退；然而，一些蛀牙永远不会闭合，一小部分会导致并发症，如出血、气胸或脓胸。尚未研究唑类抗真菌治疗对球虫蛀牙的影响。因为唑类是有症状的肺球孢子菌病的常见治疗方法，我们旨在评估唑类治疗对空洞闭合的影响。从 2004 年 1 月 1 日到 2014 年 12 月 31 日，我们回顾性地确定了 313 名空洞性球孢子菌病患者，排除了 42 名手术切除空洞的患者，留下 271 个数据集可供研究。271 名患者中，221 名（81.5%）在 5 年随访期间接受了唑类治疗；50 名患者未接受抗真菌治疗。在 271 名患者中，38 名（14.0%）蛀牙闭合。统计模型显示，与未治疗组相比，治疗组患者的蛀牙更容易闭合（风险比，2.14 [95% CI：1.45-5.66]）。与非吸烟者相比，主动吸烟者的蛀牙闭合率更低（11/41 [26.8%] vs 97/182 [53.3%]；P = 0.002）或患有糖尿病的人比没有糖尿病的人（27/74 [36.5%] vs 81/ 149 [54.4%]；P = 0.01)。我们没有发现空腔大小和闭合之间的关联。我们的研究结果为进一步研究这部分球孢子菌病患者的治疗方案提供了依据。总结 球孢子菌病，称为谷热，是一种真菌感染，很少会导致肺部形成空洞，这可能会导致长期肺部症状。