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Through a retrospective review, we identified 77 previously unreported cases of coccidioidomycosis during HIV infection. Patients were classified into 1 of 6 categories based on their primary clinical presentation: 20 had focal pulmonary disease (Group 1), 31 had diffuse pulmonary disease (Group 2), 4 had cutaneous coccidioidomycosis (Group 3), 9 had meningitis (Group 4), 7 had extrathoracic lymph node or liver involvement (Group 5), and 6 has positive coccidioidal serology without a clinical focus of infection (Group 6). Coccidioidal serologies were positive on initial testing in 83% of the patients in whom such serologic testing was performed. Sera from 39% of patients were positive for TP antibodies while 74% had CF antibodies. Eleven of 12 seronegative patients had pulmonary disease (Group 1 or 2). Serologic results of other patients sent to a single reference laboratory were similar, with 26% positive for immunodiffusion TP antibodies and 79% positive for immunodiffusion CF antibodies. For the 77 patients in this study, the CD4-lymphocyte count was below 0.250 X 10(9) cells/L in 46 of the 55 patients who had this test performed, and a low CD4 count was significantly associated with mortality (p less than 0.01). At the time of follow-up, 32 of the 77 patients (42%) had died. There were significantly more deaths in those with diffuse pulmonary disease (Group 2) than in other groups (p less than 0.001). Amphotericin B, ketoconazole, fluconazole, and itraconazole were all used as antifungal therapies. Outcome could not be related to the therapy used. Of note, 3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Forty-three states permit corporal punishment in schools. This practice continues despite the universal opposition of professional organizations, including the American Academy of Pediatrics. This study determines parental attitudes concerning the use of physical punishment in schools. The surveyed sample is drawn from parents of military dependents who brought their children to this clinic for routine physical examinations. One hundred and twenty-nine of 132 questionnaires were returned for a 98% response rate. Fifty-one percent of the parents supported the use of corporal punishment in schools, 37% disagreed (77% of these strongly), 11% had no opinion, and 1% did not respond to the question. Analysis of the responses displayed a relationship between parental attitudes on the use of corporal punishment and opinion of the positive effects of physical punishment on children's behavior (p less than 0.0001). No relationship was found between position on corporal punishment and the respondent (mother, father, or both), the age of parents, the military rank of the sponsor (the individual whose military service makes the child eligible for military medical care, i.e., father, mother, guardian, etc.), the sex of the children, the marital status of the parents, or the schools attended by the children (public or private). Thirty-four percent of parents believed corporal punishment would improve behavior, and 20% of parents felt that physical punishment would improve their child's academic performance.

A woman with coccidiodal meningitis had two successive pregnancies and was treated with intrathecal amphotericin B. The outcome was successful.