Coccidioides
Rossana de Aguiar Cordeiro in Pocket Guide to Mycological Diagnosis, 2019
Coccidioidomycosis is a neglected disease in South America, and many cases are expected to be misdiagnosis with tuberculosis—an endemic disease in many Latin America countries. In Brazil, an epidemiological link between coccidioidomycosis and hunting armadillos had been extensively described. Handling of Coccidioides cultures requires BSL-3 facilities and well trained personnel. Clinical laboratories in endemic areas should provide at least immunological tests for presumptive diagnosis of coccidioidomycosis.
Miscellaneous Respiratory Infections
Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace in Pulmonary Infection, 2004
121 Miscellaneous Respiratory Infections7.4 Chest radiograph from a patient with emphysema who presented with fibrocavitatory disease (particularly in the upper lobes) due to histoplasmosis. 7.5 Photomicrograph of a section of lung from a patient with histoplasmosis, stained with PAS which stains the capsules of the spores red (arrow). 122 Miscellaneous Respiratory InfectionsmIB7.6A Chest radiograph showing a prominent right hilum and distal consolidation (arrow) due to coccidiomycosis. 7.6B Lateral chest radiograph showing an area of homogenous increased density within the apical segment of the right lower lobe (arrow) due to coccidiomycosis. 123 Miscellaneous Respiratory InfectionsCoccidiomycosisCoccidiomycosis is a chronic lung infection caused by inhalation of fungal spores. Most infections are mild or asymptomatic, the area of focal pneumonitis healing spontaneously to leave a coin-like scar (coccidioma) or a single, small, thin-walled cavity. In a few cases, symptomatic consolidation occurs with fever, malaise, cough, and chest pain, and may progress to chronic fibronodular disease of the lung or hilar lymph nodes. Dissemination beyond the lung or hilar nodes occurs rarely. Disseminated disease is more likely in immunocompromised patients, and carries a poor prognosis. The CNS, musculoskeletal system, and skin are particularly involved. AetiologyCoccidiomycosis is caused by inhalation of the wind-borne spores (spherules) of a soil fungus, Coccidioides imitis, found in the desert regions of south-western USA, Mexico, and central and South America. Person-to-person transmission does not occur. Illustrative cases and investigationsA 68-year-old man presented with a lower respiratory tract illness following his return from Arizona.
Disseminated Histoplasmosis, Coccidioidomycosis, And Cryptococcosis
Lourdes R. Laraya-Cuasay, Walter T. Hughes in Interstitial Lung Diseases in Children, 2019
Immunocompromised patients, especially those with depressed cell-mediated immune responses, are more susceptible to disseminated coccidioidomycosis. These patients may experience a rapid, progressive pulmonary involvement which is fatal if untreated. The diffuse bilateral miliary pulmonary infiltrates seen in the disseminated disease may also be found as a primary pulmonary infection unassociated with immunodeficiency. Little has been published on the clinical features of the pulmonary and disseminated form of coccidioidomycosis in the immunosuppressed patient. However, the approach to diagnosis and the drugs available for treatment of the infection in otherwise healthy individuals are easily applied to these cases. 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. Amphotericin B is the standard drug for treatment of diffuse pneumonitis associated with systemic dissemination and in the severely immunosuppressed host.
Management of temporomandibular joint Coccidioidomycosis
Published in CRANIO®, 2016
Ziyad S. Hammoudeh, Salvatore Lettieri
Purpose: The aim of this report was to present the first known case of coccidioidomycosis involving the temporomandibular joint, review the literature regarding dissemination to the mandible, and to provide treatment recommendations for this challenging condition. Methods: Coccidioidomycosis of the mandibular condyle was identified in a 30-year-old Somali male residing in Arizona. Due to the difficulty of surgical access and the anticipated temporomandibular joint morbidity of radical condylar debridement, primary medical management was performed. Results: Marked symptomatic improvement was observed after 10 days of IV antifungal therapy. Resolution of the abscess with residual bony destruction was observed on CT scan. Based on the results of this patient and review of the literature, an algorithm is presented to help guide management of coccidioidomycosis dissemination to the mandible. Conclusion: Prolonged antifungal therapy should be attempted for initial management of a Coccidioides abscess involving the condyle with early surgical intervention reserved for the more easily accessible and less functionally compromising portions of the mandible.
Coccidioidomycosis with Diffuse Miliary Pneumonia
Published in Baylor University Medical Center Proceedings, 2016
David Sotello, Marcella Rivas, Audra Fuller, Tashfeen Mahmood, Menfil Orellana-Barrios, Kenneth Nugent
Coccidioidomycosis is a well-known infection in the southwestern United States, and its occurrence is becoming more frequent in endemic areas. This disease can have a significant economic and medical impact; therefore, accurate diagnosis is crucial. In conjunction with patient symptoms, residence in or travel to an endemic area is essential for diagnosis. Diagnosis is usually made with serology, culture, or biopsy and confirmed with DNA probe technology. Pulmonary disease is the most common presentation and is seen in almost 95% of all cases. One-half to two-thirds of all Coccidioides infections are asymptomatic or subclinical. Most pulmonary infections are self-limited and do not require treatment except in special populations. When treatment is warranted, itraconazole and fluconazole are frequently used. Diffuse miliary pneumonia is uncommon and is especially rare in immunocompetent patients. Herein we describe a rare presentation of miliary coccidioidomycosis in a nonimmunocompromised patient.
COCCIDIOIDOMYCOSIS: AN UNEXPECTED DIAGNOSIS IN A PATIENT WITH PERSISTENT COUGH
Published in Acta Clinica Belgica, 2009
T. Goegebuer, K. Nackaerts, U. Himpe, E. Verbeken, K. Lagrou
Coccidioidomycosis is an endemic fungal infection of the new world caused by Coccidioides immitis. Because of its low incidence in the European continent, the disease is not well known in Belgium. A 34-year-old male was referred by his general physician with a chronic cough and a nodular infiltrate on chest X-ray. Because a malignant tumour was suspected, a diagnostic work-up was performed and, finally, a broad excision of the pulmonary lesion was carried out. The unsuspected diagnosis of chronic coccidioidomycosis was eventually made based on identification of the filamentous fungus in mycological culture of the lung tissue, and the presence of the typical spherules with endospores upon histopathologic examination. The patient later admitted to have been travelling to Arizona frequently in the past year for professional reasons. Coccidioides spp. should always be considered as a possible aetiologic agent of pulmonary infection in former residents and recent travellers to regions where the fungus is endemic.
Related Knowledge Centers
- Coccidioidin
- Fungal Spores
- Fungi
- Rift Valley Fever
- Mycoses
- Southwestern United States
- Coccidioides