Surgical Manifestations and Results of Treatment of Pulmonary Coccidioidomycosis

Fifty consecutive patients with pulmonary coccidioidomycosis undergoing operation in an eight-year period were analyzed with regard to clinical and roentgenographic indications, surgical procedure, complications, and recurrence. Surgical indications could be divided into operation necessary primarily for diagnosis (22 out of 50, 44%), and operation because of suspected residual complications of coccidioidomycosis requiring therapy (28 out of 50, 56%). Of 16 patients with solitary nodules, 2 had lobectomy and 14 had wedge resection with no recurrence. Of 24 patients with coccidioidomycosis cavities, 14 underwent lobectomy and 10 had lesser resections, with three recurrences.Results indicate that (1) resection for primary pulmonary coccidioidomycosis for both diagnosis and therapy is associated with low perioperative risk, (2) routine administration of amphotericin is not indicated, (3) skin tests, serological study, bronchoscopy, and mediastinoscopy may not be diagnostic, and (4) lobectomy is not necessarily indicated since lesser resections are associated with equally low recurrence and complications rates.