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Disseminated Histoplasmosis, Coccidioidomycosis, And Cryptococcosis
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The demonstration of the characteristic endosporulating spherules within secretions or infected tissues and the isolation of Coccidioides immitis in culture are the most reliable diagnostic tests. Even on standard culture media the organism grows to visible thalli within a week. The Gomori methenamine silver nitrate stain is preferred for searching infected tissues. Wet mounts of sputum samples can be viewed in 10% potassium hydroxide preparations. The skin test reaction to coccidioidin indicates delayed hypersensitivity resulting from current or past infection with C. immitis. This test is rarely of diagnostic help in the compromised patient. Serum IgM precipitins may be detected 1 to 3 weeks after the onset of symptoms. In disseminated forms of the infection complement-fixation titers are usually high.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Coccidioidomycosis is a systemic mycosis due to the dimorphic fungus Coccidiodes immitis, less frequently C. posadasii. It results from inhalation of the fungus and may remain asymptomatic, or run a benign, a serious, or a fatal course. It affects immunocompetent as well as immunocompromised subjects as a primary pathogen or an opportunistic agent, respectively. Most cases are seen in California, Arizona, and bordering Mexico with 60% remaining asymptomatic. All persons living or travelling to endemic areas are exposed. Many animals including cats and dogs are infected.268 All ages and both sexes are affected. In severe cases of disseminated coccidioidomycosis, bones and joints may be involved and thus nail unit and skin lesions secondarily occur in 15%–20% of the cases.269 Primary skin infection is very rare, mostly resulting from accidental inoculation in laboratories or autopsy rooms,270,271 rarely as infection resulting from an injury by a thorn or splinter.272,273 One to three weeks after the inoculation, a tender nodule forms that enlarges to a plaque and ulcerates. Regional lymphangitis and lymphadenitis follow. Healing takes several months. The coccidioidin test aids in making, or confirming, the diagnosis. Treatment of severe cases is with intravenous amphotericin B, which is a relatively toxic regimen. Alternatives are posaconazole, ketoconazole, and the triazoles itraconazole and fluconazole. Trials have been performed with nikkomycin Z, which inhibits chitin synthetase, caspofungin, and voriconazole.
Clinical and Radiological Diagnosis and Causes of Pulmonary Granulomas
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Coccidioidomycosis is endemic in the southwestern United States, northern Mexico, and certain parts of central and South America. One-third of the patients develop primary infection after an incubation period of one to three weeks. About two-thirds of infected patients are asymptomatic. Primary coccidioidomycosis is associated with a flu-like illness, fever, chills, erythema nodosum, malaise, and night sweats. Chest X-ray films may show hilar adenopathy, pulmonary infiltrates, and pleural effusion. About 0.5% of patients develop disseminated disease with involvement of meninges, brain, bone, joints, and skin. Serological tests, fungal culture, and demonstration of coccidioidin spherules in the tissue are useful in establishing the diagnosis of coccidioidomycosis (7).
Endemic mycoses: epidemiology and diagnostic strategies
Published in Expert Review of Anti-infective Therapy, 2020
Andrés Tirado-Sánchez, Gloria M. González, Alexandro Bonifaz
Intradermal reactions to coccidioidin skin tests, as well as the analysis of specific antibodies by complement fixation, are the most used immunological diagnostic methods for CDM. Both tests are useful for prognosis [76,77].