Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors
Baker, E.J.; Hawkins, J.A.; Waskow, E.A.
Journal of Thoracic and Cardiovascular Surgery 75(5): 680-687
1978
ISSN/ISBN: 0022-5223 PMID: 642560 Document Number: 127456
Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. Perioperative therapy with amphotericin B may be of value in the adult surgical candidate with progressive disease but is not necessary or desirable in the juvenile diabetic patient. Coccidioidomycosis is a disease of relative immunocompromise, and a negative skin test should herald such compromise and support a decision for surgery. Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.