Clinical Scoring System of the NAIAD Mycoses Study Group for Therapeutic Response in a Patient with Coccidioidomycosis

Parameters for the score:

(1) symptoms

(2) lesions

(3) cultures

(4) serology: antibody titer by immunodiffusion

Symptoms:

(1) 1 point was assigned for each symptom present.

(2) The list of symptoms is not given in the 1990 report, but would include fever, night sweats, anorexia, nonintentional weight loss, and disability.

Lesions:

(1) For the pretreatment score, every lesion in any organ site was counted.

(2) At followup each lesion was compared to its pretreatment size.

(3) The lesional value was the sum of the severity factors for all lesions.

where:

• The text describes the scoring as the summation of the number of lesions times the severity factor.

• In the 1988 report lesions were assessed separately for size by physical examination and on imaging studies.

points for culture =

= 4 * (number of sites for which culture is positive)

where:

• The sites that were positive on the pretreatment evaluation were recultured on subsequent visits.

where:

• Apparently the antibody titer drops off as the infection resolves, but I am not sure what the rate of loss is. Evaluation seems to be every 3 months or so, so this may be the required timeframe for change.

pretreatment score =

= SUM(points for all 4 parameters prior to therapy)

score at followup =

= SUM(points for all 4 parameters at assessment time)

score at followup as percent of pretreatment score =

= (score at followup) / (pretreatment score) * 100%

Interpretation:

• To be evaluated using the scoring system, the pretreatment score had to be 4 or greater.

• A decrease in the followup score was considered improvement.

• An increase in the followup score was considered progressive disease.

• Successful treatment ("remission") was defined as a cumulative score < 50% of the pretreatment score.

• Treatment failure was defined as anyone who had not achieved remission by the time of treatment completion.

• Relapse is defined as a remission at the completion of treatment followed by a return to the posttreatment score to > 50% of the pretreatment value