{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:06:40Z","timestamp":1785467200890,"version":"3.56.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T00:00:00Z","timestamp":1597104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The natural history of non\u2013central nervous system (non-CNS) disseminated coccidioidomycosis (DCM) has not been previously characterized. The historical Veterans Affairs (VA)\u2013Armed Forces coccidioidomycosis patient group provides a unique cohort of patients not treated with standard antifungal therapy, allowing for characterization of the natural history of coccidioidomycosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective study of 531 VA\u2013Armed Forces coccidioidomycosis patients diagnosed between 1955\u20131958 and followed to 1966. Groups were identified as non-DCM (462 patients), DCM (44 patients), and CNS (25 patients). The duration of the initial infection, fate of the primary infection, all-cause mortality, and mortality secondary to coccidioidomycosis were assessed and compared between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mortality due to coccidioidomycosis at the last known follow-up was significantly different across the groups: 0.65% in the non-DCM group, 25% in the DCM group, and 88% in the CNS group (P\u2005&amp;lt;\u2005.001). The primary fate of pulmonary infection demonstrated key differences, with pulmonary nodules observed in 39.61% of the non-DCM group, 13.64% of the DCM group, and 20% of the CNS group (P\u2005&amp;lt;\u2005.001). There were differences in cavity formation, with 34.20% in the non-DCM group, 9.09% in the DCM group, and 8% in the CNS group (P\u2005&amp;lt;\u2005.001). Dissemination was the presenting manifestation or was concurrent with the initial infection in 41% and 56% of patients in the non-CNS DCM and CNS groups, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This large, retrospective cohort study helps characterize the natural history of DCM, provides insight into the host immunologic response, and has direct clinical implications for the management and follow-up of patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1154","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T03:26:22Z","timestamp":1596511582000},"page":"e3814-e3819","source":"Crossref","is-referenced-by-count":43,"title":["Natural History of Disseminated Coccidioidomycosis: Examination of the Veterans Affairs\u2013Armed Forces Database"],"prefix":"10.1093","volume":"73","author":[{"given":"Derek J","family":"Bays","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of California\u2013Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"George R","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of California\u2013Davis Health, Sacramento, California, USA"},{"name":"Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Reef","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary\/Critical Care and Palliative Medicine, University of Arizona-Tucson, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana J","family":"Freifeld","sequence":"additional","affiliation":[{"name":"California Northstate University College of Medicine, Elk Grove, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milt","family":"Huppert","sequence":"additional","affiliation":[{"name":"Medical Services, Veterans Affairs Medical Center, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Salkin","sequence":"additional","affiliation":[{"name":"Medical Services, Veterans Affairs Medical Center, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Machelle D","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John N","family":"Galgiani","sequence":"additional","affiliation":[{"name":"Valley Fever Center for Excellence, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"},{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,11]]},"reference":[{"key":"2021121011173186200_CIT0001","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2021121011173186200_CIT0002","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.idc.2015.10.008","article-title":"Coccidioidomycosis","volume":"30","author":"Stockamp","year":"2016","journal-title":"Infect Dis Clin North Am"},{"key":"2021121011173186200_CIT0003","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/archinte.1938.00180160132011","article-title":"Coccidioides infection (coccidioidomycosis). 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