{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:43:41Z","timestamp":1764873821524},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"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":[[2021,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:label \/>\n                  <jats:p>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\u20135.66]). Cavities were less likely to close in active smokers than nonsmokers (11\/41 [26.8%] vs 97\/182 [53.3%]; P\u00a0=\u00a00.002) or in persons with than without diabetes (27\/74 [36.5%] vs 81\/149 [54.4%]; P\u00a0=\u00a00.01).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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lay Summary<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/mmy\/myab011","type":"journal-article","created":{"date-parts":[[2021,3,14]],"date-time":"2021-03-14T12:07:04Z","timestamp":1615723624000},"page":"834-841","source":"Crossref","is-referenced-by-count":6,"title":["Cavitary Coccidioidomycosis: Impact of azole antifungal therapy"],"prefix":"10.1093","volume":"59","author":[{"given":"Renni R","family":"Panicker","sequence":"first","affiliation":[{"name":"Research Trainee (limited tenure), Mayo Clinic, Scottsdale, Arizona, USA, now with the Department of Internal Medicine, Louisiana State University Health Science Center, Lafayette, Louisiana, 70504, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen C","family":"Bartels","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, 85259, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B","family":"Gotway","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil M","family":"Ampel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew R","family":"Buras","sequence":"additional","affiliation":[{"name":"Biostatistics, Mayo Clinic, Scottsdale, Arizona, 85259, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth S","family":"Lim","sequence":"additional","affiliation":[{"name":"Biostatistics, Mayo Clinic, Scottsdale, Arizona, 85259, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janis E","family":"Blair","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"2021080323595561700_bib1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0891-5520(02)00040-5","article-title":"Coccidioidomycosis","volume":"17","author":"Chiller","year":"2003","journal-title":"Infect Dis Clin North Am"},{"key":"2021080323595561700_bib2","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1086\/496991","article-title":"Coccidioidomycosis","volume":"41","author":"Galgiani","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2021080323595561700_bib3","doi-asserted-by":"crossref","first-page":"623","DOI":"10.7326\/0003-4819-29-4-623","article-title":"Pathogenesis of coccidioidomycosis with special reference to pulmonary cavitation","volume":"29","author":"Smith","year":"1948","journal-title":"Ann Intern Med"},{"key":"2021080323595561700_bib4","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/978-1-4612-3730-3_6","article-title":"Epidemiology of coccidioidomycosis","volume":"2","author":"Pappagianis","year":"1988","journal-title":"Curr Top Med Mycol"},{"key":"2021080323595561700_bib5","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1128\/CMR.00060-07","article-title":"Cavitary pulmonary disease","volume":"21","author":"Gadkowski","year":"2008","journal-title":"Clin Microbiol Rev"},{"key":"2021080323595561700_bib6","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"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":"2021080323595561700_bib7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1378\/chest.54.Supplement_1.273","article-title":"Coccidioidal pulmonary cavitation","volume":"54","author":"Hyde","year":"1968","journal-title":"Dis Chest"},{"key":"2021080323595561700_bib8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.idc.2006.06.005","article-title":"Coccidioidomycosis","volume":"20","author":"Anstead","year":"2006","journal-title":"Infect Dis Clin North Am"},{"key":"2021080323595561700_bib9","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1378\/chest.54.Supplement_1.268","article-title":"A long term study of 300 patients with cavitary-abscess lesions of the lung of coccidioidal origin. 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