Coccidioidomycosis in patients with diabetes mellitus

PURPOSE: The study reviewed the interrelationships of diabetes mellitus and coccidioidomycosis. SUBJECTS AND METHODS: We conducted a retrospective review of the medical records of immunocompetent patients with coccidioidomycosis who were treated at our academic medical institution between January 1, 1999, and October 31, 2003, to compare those with and without diabetes mellitus and to determine whether glycemia correlates with the course of illness. RESULTS: Of 329 immunocompetent patients with coccidioidomycosis, 44 had diabetes ( 4 type 1 and 40 type 2) and were divided into 2 groups: those with serum glucose concentrations of less than 12.2 mmol/ L ( 220 mg/ dL) and those with glucose concentrations of greater than or equal to 12.2 mmol/ L ( 220 mg/ dL). Persons with diabetes in either glucose group were more likely than those without diabetes to have cavitary lung disease ( relative risk, 2.94; P <. 001) and relapsed infection. However, only the diabetes group with serum glucose concentrations greater than or equal to 12.2 mmol/ L ( 220 mg/ dL) were more likely to have disseminated infection ( relative risk, 2.8; P =. 05) and to require treatment ( relative risk, 9.85; P =. 005), but their infection was less likely to resolve ( relative risk, 0.24; P =. 002). CONCLUSION: Because glycemia strongly correlated with clinical characteristics of coccidioidomycosis in this cohort, we recommend routine measurement of serum glucose in persons with coccidioidomycosis to identify patients with an increased risk of complicated infection. Future studies should evaluate the efficacy of tight glycemic control on the outcome of coccidioidal infection. (c) 2006 Elsevier Inc. All rights reserved.