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Chronic Pulmonary Coccidioidomycosis

Valley Fever


Presentation

  • This 14-year-old healthy African-American adolescent presented with widely disseminated coccidioidomycosis.[oncohemakey.com]
  • Fevers persisted along with worsening cough over the next three days, and the patient presented for further evaluation. Figure 1.[swjpcc.com]
  • The clinical presentation may be delayed weeks or months after the primary infection. Localised swelling, sometimes with a discharging sinus, is common for many sites. Bone infection may present with a pathological fracture.[life-worldwide.org]
  • He presented to the referring hospital and was found to have signs of bilateral pneumonia.[thorax.bmj.com]
  • Hilar and mediastinal adenopathy may be present in 20% of cases, usually with parenchymal findings. A small pleural effusion may occur in 20% of cases.[journals.lww.com]
Weight Loss
  • Patients develop chronic productive cough, haemoptysis, weight loss and chest pains.[life-worldwide.org]
  • loss See also: Coccidioidomycosis Skin lesion of coccidioidomycosis Exams and Tests Biopsy of lymph node or lung (often done with bronchoscopy) Blood test for antibodies to the fungus Bronchoscopy with lavage Complete blood count (CBC) Sputum smear ([dxline.info]
  • Although no findings are unique to acute coccidioidomycosis, those that tend to suggest this diagnosis include unexpectedly pronounced fever, fatigue, and weight loss and immune phenomena such as erythema nodosum. Eosinophilia may occur.[oncohemakey.com]
  • Symptoms you may experience with the chronic form include: a chronic cough blood-tinged sputum (coughed up mucus) weight loss wheezing chest pain muscle aches headache Your doctor may perform one or more of the following tests to make a diagnosis: blood[healthline.com]
  • loss Assessment-Physical Findings Fever Itchy maculopapular rash Hemoptysis Local swelling and redness in involved sites (with musculoskeletal involvement) Pleural friction rub Wheezing Crackles Decreased breath sounds; dullness on percussion; increased[quizlet.com]
Malaise
  • Meningitis Bronchiectasis Osteomyelitis Hepatosplenomegaly Liver failure Pulmonary scarring Septic arthritis Possibly asymptomatic Living or traveling to an endemic area Dry cough Pleuritic chest pain Sore throat Chills Malaise Headache Joint pain Night[quizlet.com]
  • Case Report A 71-year-old man presented to the emergency room in Tucson, Arizona with a one-week history of fever, cough, and malaise. The patient’s symptoms began while returning from a trip to northern California.[swjpcc.com]
Pleural Effusion
  • A small pleural effusion may occur in 20% of cases. Approximately 5% of patients with primary disease are left with chronic, residual lesions of the lung.[journals.lww.com]
  • Pleural effusion Pleural effusion is seen in 5-15% of patients, although pleuritic chest pain occurs more frequently (in 50-75% of cases), as determined clinically.[emedicine.medscape.com]
  • The other 40% will develop symptomatic disease that manifests with variable signs and symptoms, predominantly an influenza-like syndrome, pneumonia, or pleural effusion.[ncbi.nlm.nih.gov]
  • Plain radiograph and CT chest There can be many findings which include consolidation (most common - 75%), multiple nodules, interlobular septal thickening, lymph node enlargement (including bilateral hilar lymphadenopathy ), and pleural effusions 3-6.[radiopaedia.org]
  • Diagnostic Test Results-Imaging Chest X-ray shows bilateral diffuse infiltrates, nodules, mediastinal or hilar adenopathy, or pleural effusion.[quizlet.com]
Hemoptysis
  • About one-third of the patients with cavities may experience hemoptysis (coughing blood). The hemoptysis is often recurrent but generally not life-threatening. If rupture of the cavity is a large possibility, surgical removal may be necessary.[medicalopedia.org]
  • Hemoptysis or the threat of rupture into the pleural space occasionally necessitates surgery.[merckmanuals.com]
  • […] scarring Septic arthritis Possibly asymptomatic Living or traveling to an endemic area Dry cough Pleuritic chest pain Sore throat Chills Malaise Headache Joint pain Night sweats Weight loss Assessment-Physical Findings Fever Itchy maculopapular rash Hemoptysis[quizlet.com]
  • A 37-year-old man who had lived in Arizona from 2008 to 2010 presented with cough and hemoptysis in January 2010. Pulmonary tuberculosis was suspected based on his chest X-ray film exhibiting a cavity in the right upper lung field.[ci.nii.ac.jp]
  • Such patients may display pulmonary cavities with walls that appear thicker than that seen in classical coccidioidal cavities ( Figure 179.2 ) and chronic symptoms of dry or productive cough, chest pain, shortness of breath, and hemoptysis, each of which[oncohemakey.com]
Productive Cough
  • She presented with 1 week of low-grade fever and increasing productive cough. Her lateral chest radiograph shows a chronic cavity with thickened walls and an air–fluid level consistent with bacterial superinfection.[oncohemakey.com]
  • Patients develop chronic productive cough, haemoptysis, weight loss and chest pains.[life-worldwide.org]
  • Case report A 48 year old Caucasian man had developed a ‘flu-like illness followed by dyspnoea and a productive cough shortly after arriving in the UK for a Christmas holiday.[thorax.bmj.com]
Rales
  • The patient was in moderate respiratory distress with rales auscultated in the right upper lung zone. Subsequent laboratory examination revealed a PaO2 of 69 mmHg on 4 liters-per-minute of oxygen via nasal cannula.[swjpcc.com]
  • Physical signs may be absent or limited to scattered rales with or without areas of dullness to percussion over lung fields.[merckmanuals.com]
Chronic Productive Cough
  • Patients develop chronic productive cough, haemoptysis, weight loss and chest pains.[life-worldwide.org]
Cranial Nerve Involvement
  • Abscess formation, cranial nerve involvement, myelitis, arachnoiditis, and syrinx formation, as well as cerebral vasculitis are also occasionally seen. Figure 179.5 Coccidioidal Only gold members can continue reading. Log In or Register to continue[oncohemakey.com]
Lethargy
  • Coccidioidal meningitis presents sub-acutely, similarly to tuberculous meningitis, with headache, lethargy and declining mental status. Frequency and global burden Coccidioidomycosis is restricted to the Americas (see map).[life-worldwide.org]

Workup

  • The chest radiographic patterns of coccidioidomycosis have a broad differential diagnosis; therefore, careful clinical evaluation and workup are recommended to exclude other disorders.[emedicine.medscape.com]
Bilateral Pulmonary Infiltrate
  • Despite antifungal therapy his pulmonary status worsened with progressive bilateral pulmonary infiltrates and worsening hypoxemic respiratory failure (Figure 3). Figure 3.[swjpcc.com]
Pleural Effusion
  • A small pleural effusion may occur in 20% of cases. Approximately 5% of patients with primary disease are left with chronic, residual lesions of the lung.[journals.lww.com]
  • Pleural effusion Pleural effusion is seen in 5-15% of patients, although pleuritic chest pain occurs more frequently (in 50-75% of cases), as determined clinically.[emedicine.medscape.com]
  • The other 40% will develop symptomatic disease that manifests with variable signs and symptoms, predominantly an influenza-like syndrome, pneumonia, or pleural effusion.[ncbi.nlm.nih.gov]
  • Plain radiograph and CT chest There can be many findings which include consolidation (most common - 75%), multiple nodules, interlobular septal thickening, lymph node enlargement (including bilateral hilar lymphadenopathy ), and pleural effusions 3-6.[radiopaedia.org]
  • Diagnostic Test Results-Imaging Chest X-ray shows bilateral diffuse infiltrates, nodules, mediastinal or hilar adenopathy, or pleural effusion.[quizlet.com]

Treatment

  • RESULTS: Seventeen (85%) of 20 patients had a satisfactory response to treatment. The median duration of treatment was 173 days.[ncbi.nlm.nih.gov]
  • Patients who do not respond to fluconazole or itraconazole treatment are candidates for intrathecal amphotericin B therapy with or without continuation of azole treatment.[academic.oup.com]
  • For more detailed treatment guidelines, please refer to the Infectious Diseases Society of America’s Practice Guidelines for the Treatment of Coccidioidomycosis External.[cdc.gov]
  • The acute disease usually goes away without treatment.[dxline.info]
  • Courses of typically recommended treatment range from 3 to 6 months.[academic.oup.com]

Prognosis

  • Treatment and prognosis The mainstay of medical treatment of pulmonary coccidioidomycosis is with anti-fungal agents such as fluconazole 7.[radiopaedia.org]
  • Outlook (Prognosis) The outlook in milder cases is usually good.[dxline.info]
  • Outlook and prognosis Coccidioidal meningitis needs to be treated lifelong, as it is incurable. Complications including communicating hydrocephalus.[life-worldwide.org]
  • Prognosis; Complications About 40% of those infected develop symptomatic disease, usually pulmonary. About 90% will resolve their pulmonary maladies without lasting consequences.[diagnose-me.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Many were thought to have tuberculosis for years before the fungal etiology of the lung disease was determined.[nejm.org]
  • In regions where endemic fungal infections are common, differentiating between eosinophilic pneumonias of idiopathic versus infectious etiology is vital in order to avoid inappropriate therapy and its adverse consequences.[swjpcc.com]
  • (Etiology) Acute Pulmonary Coccidioidomycosis is an airborne-infection that is acquired by inhalation of the coccidioides spores present in air (carried by dust) This infection may be caused by any of the two coccidioides species of fungus that include[dovemed.com]
  • Determining pulmonary lesions that evolve into residual nodules is useful because it obviates the need for establishing the nodule's etiology at a future time.[academic.oup.com]

Epidemiology

  • This review summarizes the ecology, epidemiology, manifestations of disease, and treatment options currently available for coccidioidomycosis. Keywords coccidioidomycosis - Coccidioides - Valley Fever - treatment - epidemiology - review[thieme-connect.com]
  • Because this test is positive in most people in endemic areas, its primary value is for epidemiologic studies rather than for diagnosis.[merckmanuals.com]
Sex distribution
Age distribution

Prevention

  • Avoiding travel to regions where this fungus is found will prevent this disorder.[dxline.info]
  • Centers for Disease Control and Prevention Coccidioides complement fixation (Medical Encyclopedia) Coccidioides precipitin (Medical Encyclopedia) Coccidioidomycosis (Medical Encyclopedia) CSF coccidioides complement fixation (Medical Encyclopedia) [ Read[icdlist.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • No evidence from randomized trials exists to determine whether antifungal treatment for uncomplicated coccidioidal infections reduces symptom duration or prevents complications. Some infections will resolve without antifungal treatment.[cdc.gov]

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