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Coccidioidomycosis

Valley Fever

Coccidioidomycosis is a fungal infection caused by Coccidioides.

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Presentation

Coccidioidomycosis may occur initially as a mild acute diseases referred to as “Valley fever” but can later progress into a more serious form of the disease that may be in chronic or disseminated form. The symptomatology of coccidioidomycosis and its presentation vary considerably depending on the stage of the disease. These signs and symptoms of coccidioidomycosis are seen in the following stages of the disease:

Acute coccidioidomycosis

The initial form of coccidioidomycosis appears to be mild with a few signs and symptoms. Onset of symptomatology often occurs one to three weeks after the spore exposure. Complains of flu-like symptoms like: fever, chills, cough, headache, arthralgia, and fatigue. Cutaneous spotty rashes may occur in the thorax and the extremities. Severe constricting chest pain may also occur resembling that of a heart attack.

Chronic coccidioidomycosis

This condition progresses from acute form when symptoms fail to resolve during the acute phase of the disease. Chronicity of coccidioidomycosis most of the time progress to pneumonia which are commonly seen in immunocompromised hosts. The following signs and symptoms are commonly seen in chronic coccidioidomycosis: Weight loss, low grade fever, recurrent cough, persistent chest pain, blood tinged expectorations, and nodules in the lungs.

Disseminated coccidioidomycosis

This condition is the most severe form of coccidioidomycosis, where the infection has already gone beyond the lungs to infect other organs like the skin, bones, liver, brain, meninges and the heart. Symptomatology depends on the organ where the infection affects and commonly presents as: Nodules and ulcers of the skin, painful lesions of the skull, bones and spine, swollen ankle and knee joints, and meningitis which is the most deadly among its complications.

Fever
  • Valley fever is a fungal lung infection that can be devastating. Learning about Valley fever can help you and your doctor recognize the symptoms early. Valley fever is an infection caused by a fungus that lives in the soil.[cdc.gov]
  • Valley fever experts said the hard numbers on valley fever-related deaths could finally start to draw attention to the disease. Valley fever is often referred to as an “orphan disease” that isn’t very prevalent. But Dr.[reportingonhealth.org]
  • Persons at risk for Valley Fever or for getting severe illness from Valley Fever should avoid exposure to dusty air in areas where Valley Fever is common.[web.archive.org]
  • Background Researchers estimate that each year more than 150,000 people nationwide contract an airborne fungus known as valley fever, or coccidioidomycosis. People can contract valley fever by breathing in cocci fungal spores.[californiahealthline.org]
  • Even if inmates at high risk for valley fever are transferred out of Avenal and Pleasant Valley, Callison said, the state would continue efforts intended to reduce valley fever in the prisons. “Anyone, in theory, can get valley fever,” he said.[voiceofoc.org]
Pain
  • They tend to resemble those of the flu, and can range from minor to severe, including: Fever Cough Chest pain Chills Night sweats Headache Fatigue Joint aches Red, spotty rash The rash that sometimes accompanies valley fever is made up of painful red[mayoclinic.org]
  • Our case presented with several years of back pain and a pelvic mass mistaken for possible malignancy by image study. 2015 by the Association of Clinical Scientists, Inc.[ncbi.nlm.nih.gov]
  • The eye was blind and painful so it was removed.[ncbi.nlm.nih.gov]
  • This case study discusses a 46-year-old male who presented to the author's outpatient urology clinic in central California with painful left scrotal swelling and who was eventually diagnosed with testicular coccidioidomycosis.[ncbi.nlm.nih.gov]
  • Coccidioidomycosis or valley fever is a fungal infection characterized by coughing, fever, shortness of breath, and chest pain caused by a fungus called Coccidioides.[symptoma.com]
Fatigue
  • Patients were also asked to indicate their level of fatigue on a 10-point scale in an attempt to correlate levels of fatigue to use of specific integrative medicine modalities.[ncbi.nlm.nih.gov]
  • ., Mexico, and Central America and that may be asymptomatic or present as a mild to serious flu-like illness marked chiefly by fever, cough, sore throat, headache, fatigue, and pneumonia but sometimes becoming disseminated beyond the lungs especially[merriam-webster.com]
  • People who develop symptoms most often experience a flu-like illness, with fever, cough, headache, fatigue, rash, and muscle aches from which they recover within several months.[dhs.wisconsin.gov]
  • It can take months to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.[mayoclinic.org]
Weight Loss
  • The patient had nonspecific symptoms of pulmonary infection, including weakness, anorexia, and weight loss. Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion.[ncbi.nlm.nih.gov]
  • He denied cough, fever, chills, night sweats, weight loss, joint/bone pain, or prior trauma to the area.[ncbi.nlm.nih.gov]
  • Fever, inappetence, and weight loss were present in 44% of the cats. Duration of clinical signs before diagnosis was less than 4 weeks in 85% (n 42) of cats, with an average of 3.8 weeks and a median of 2 weeks.[ncbi.nlm.nih.gov]
  • The initial symptoms are often non-specific, but pulmonary involvement characterized by cough, fever, malaise and weight loss - and confirmed by radiological evidence of pulmonary interstitial infiltrates - can be prominent.[apps.who.int]
  • Patients develop chronic productive cough, haemoptysis, weight loss and chest pains.[life-worldwide.org]
Chills
  • He denied cough, fever, chills, night sweats, weight loss, joint/bone pain, or prior trauma to the area.[ncbi.nlm.nih.gov]
  • When symptoms occur, they resemble symptoms of influenza or pneumonia : fever , chills, headache , severe pain in the joints, chest pain, and coughing. In a few instances after recovery there are solid lesions or cavities in the lungs.[britannica.com]
  • When symptoms occur, they resemble symptoms of influenza or pneumonia : fever, chills, headache, severe pain in the joints, chest pain, and coughing. In a few instances after recovery there are solid lesions or cavities in the lungs.[britannica.com]
  • HISTORY This 17-year-old Filipino female in the southern San Joaquin Valley of California presented with a 3 week history of progressive dyspnea on exertion and orthopnea accompanied by fever, chills, pleuritic chest pain, weight loss, and general debilitation[hcplive.com]
  • The primary disease may produce no symptoms at all or may produce a fever, chills and cough. This infection may heal completely, or result in other complications, including permanent damage to the lungs.[southernnevadahealthdistrict.org]
Cough
  • Abstract A 35-year-old man presented at the outpatient department of pulmonary diseases with fever, rhinitis and coughing. He had recently been on holiday in California.[ncbi.nlm.nih.gov]
  • In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission.[ncbi.nlm.nih.gov]
  • Signs and symptoms include: Low-grade fever Weight loss Cough Chest pain Blood-tinged sputum (matter discharged during coughing) Nodules in the lungs Disseminated coccidioidomycosis The most serious form of the disease, disseminated coccidioidomycosis[mayoclinic.org]
  • A 34-year-old male was referred by his general physician with a chronic cough and a nodular infiltrate on chest X-ray.[ncbi.nlm.nih.gov]
  • The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes.[ncbi.nlm.nih.gov]
  • Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion.[ncbi.nlm.nih.gov]
  • Coccidioides imitus  Soil fungus endemic to Southwest (San Joaquin Valley) Primary Coccidioidomycosis  Most are asymptomatic  Clinically, may have arthralgias, skin rash  X-ray  Patchy infiltrates mainly in lower lobes (80%)  Hilar adenopathy (20%)  Pleural[learningradiology.com]
  • […] imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar adenopathy (20%) • Pleural[learningradiology.com]
  • 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]
Dyspnea
  • The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain.[ncbi.nlm.nih.gov]
  • CASE REPORT: The case of a Mexican HIV patient who developed fever, general malaise, a severe cough, and dyspnea during a stay in Acapulco, Guerrero, Mexico, is presented.[ncbi.nlm.nih.gov]
  • Illness and treatment: Symptoms can include fever, fatigue, cough, dyspnea, headache, night sweats, myalgias, and rash. Typical presentations are shortness of breath and pneumonia.[doh.wa.gov]
  • Of those that do experience symptoms, the most common symptoms tend to be mild and flu-like, including: Fever Headache Cough Fatigue Chest pain Chills Shortness of breath (dyspnea) Muscle pain (myalgia) Joint pain (arthralgia) A rash will develop in around[infectiousdiseases.about.com]
Hemoptysis
  • Hemoptysis or the threat of rupture into the pleural space occasionally necessitates surgery.[msdmanuals.com]
  • Pneumothorax accounted for 24 % of complications with 7 % of pneumothoraces requiring chest tube. 1.5 % were complicated by hemoptysis but none required blood transfusions.[ncbi.nlm.nih.gov]
  • Patients with mild or self-limiting infections will present with: Low-grade fever with chills and night sweats Fatigue Pain (headaches, sore throat, chest pain) A cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite[dermnetnz.org]
  • 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]
Dry Cough
  • We describe the case of a previously healthy man presenting to a Dublin hospital with fever, dry cough and chest pain, following a visit to the western USA.[ncbi.nlm.nih.gov]
  • Symptoms can last weeks to months and include Fever Cough, which can be a dry cough, a cough with phlegm, or a cough with bloody phlegm Flu-like symptoms such as muscle pain, joint pain, headache, and fatigue Rash The diagnosis of valley fever is based[jamanetwork.com]
  • Symptoms of acute coccidioidomycosis include fever, headache, rash, muscle aches, dry cough, weight loss, and malaise.[cdc.gov]
Loss of Appetite
  • G.A.Buijze@amc.uva.nl Abstract We report the case of a 58 year old male patient with nonproductive coughing, fever, vomiting and loss of appetite, beginning at the moment that he returned back home from a 2 week holiday in California.[ncbi.nlm.nih.gov]
  • Symptoms you may experience with the acute form include: cough loss of appetite fever shortness of breath Symptoms of the chronic form are similar to those of tuberculosis.[healthline.com]
  • Symptoms you may experience with the acute form include: cough loss of appetite fever shortness of breath Symptoms of the chronic form are similar to those of tuberculosis .[healthline.com]
  • Common symptoms include: Ankle, feet, and leg swelling Chest pain (can vary from mild to severe) Cough, possibly producing blood-tinged phlegm (sputum) Fever and night sweats Headache Joint stiffness and pain or muscle aches Loss of appetite Painful,[medlineplus.gov]
  • Patients with mild or self-limiting infections will present with: Low-grade fever with chills and night sweats Fatigue Pain (headaches, sore throat, chest pain) A cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite[dermnetnz.org]
Hepatosplenomegaly
  • […] localized destruction of the outer table of the skull, or in the vertebral body, arch, or processes. 6 7 Lumbar spine, lower extremity, and follow-up chest radiographs were obtained to stage progression of her disease revealing increased heart size, massive hepatosplenomegaly[hcplive.com]
Chest Pain
  • Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing.[mayoclinic.org]
  • We describe the case of a previously healthy man presenting to a Dublin hospital with fever, dry cough and chest pain, following a visit to the western USA.[ncbi.nlm.nih.gov]
  • Coccidioidomycosis or valley fever is a fungal infection characterized by coughing, fever, shortness of breath, and chest pain caused by a fungus called Coccidioides.[symptoma.com]
  • Occasionally, these cavities rupture, causing chest pain and difficulty breathing, and require surgical repair.[vfce.arizona.edu]
  • They may include: chest pain - may be mild or quite severe chills cough fatigue fever headache joint aches muscle aches night sweats shortness of breath A skin rash can occur.[medicalnewstoday.com]
Night Sweats
  • He denied cough, fever, chills, night sweats, weight loss, joint/bone pain, or prior trauma to the area.[ncbi.nlm.nih.gov]
  • The fungus is Coccidioides immitis, subdivision Deuteromycotina ‘Persons with coccidioidomycosis may present with cough, fever, and night sweats.’[oxforddictionaries.com]
  • Illness and treatment: Symptoms can include fever, fatigue, cough, dyspnea, headache, night sweats, myalgias, and rash. Typical presentations are shortness of breath and pneumonia.[doh.wa.gov]
  • Other people may have flu-like symptoms, including: Fatigue (tiredness) Cough Fever Shortness of breath Headache Night sweats Muscle aches or joint pain Rash on upper body or legs The symptoms of Valley fever can be similar to those of other common illnesses[cdc.gov]
Skin Ulcer
  • Disseminated coccidioidomycosis, or coccidioidal granuloma, is a progressive form of infection that can result in skin ulcers, many nodules or cavities in the lungs, widespread involvement of lymph nodes, lesions of the bones, and osteomyelitis (infection[britannica.com]
  • If the fungus spreads (disseminates) throughout the body, it can cause problems ranging from skin ulcers and abscesses to bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis — a potentially fatal infection of the[mayoclinic.org]
  • Complications can include: Skin ulcers and abscesses Swollen and painful joints Bone lesions Heart inflammation Urinary tract problem Meningitis Meningitis is by far the most serious complication.[infectiousdiseases.about.com]
Eruptions
  • Reactive, immunologically mediated eruptions include erythema nodosum, a generalized exanthem, Sweet syndrome, and reactive granulomatous dermatitis.[ncbi.nlm.nih.gov]
  • Others may have a raised red rash with blisters or eruptions that look like pimples.[mayoclinic.org]
  • Once inside the lungs, the fungal spores can multiply and create eruptive nodules in the airways. In people with severe immune supression—particularly those diagnosed with AIDS —this lead to severe lung infections.[infectiousdiseases.about.com]
Arthritis
  • Abstract We report a case of Coccidioidomycosis of the cranium that presented as a cystlike structure with adjoining bone destruction in a 40-year-old patient with underlying rheumatoid arthritis that was treated with a combination of lipid amphotericin[ncbi.nlm.nih.gov]
  • Complications Pneumonia *, arthritis, meningitis, and other serious problems can result if the infection spreads throughout the lungs or to other parts of the body, such as the liver, heart, brain, bones, or joints.[humanillnesses.com]
  • BY Rachel Cook and Rebecca Plevin ReportingonHealth Collaborative More people are dying from valley fever than previously thought, and illnesses including diabetes, lung disease, arthritis and certain cancers may increase a person’s chances of dying from[reportingonhealth.org]
  • Vertebral osteomyelitis and septic arthritis have been most frequently associated with disseminated coccidioidomycosis, but this disease can cause lytic bone lesions throughout the body indistinguishable from malignancy.[shmabstracts.com]
  • […] of cases) Rarely, infected tendon sheaths demonstrating a villonodular synovitis Although arthritis is usually monoarticular, it can be migratory in nature.[emedicine.medscape.com]
Arthralgia
  • Common symptoms (median 3 mo) included pain/arthralgia (21) and swelling (10). Cultures and serology were positive in 15 of 17 (88%) and 19 of 22 patients (86%), respectively.[ncbi.nlm.nih.gov]
  •  Caused by Coccidioides imitus  Soil fungus endemic to Southwest (San Joaquin Valley) Primary Coccidioidomycosis  Most are asymptomatic  Clinically, may have arthralgias, skin rash  X-ray  Patchy infiltrates mainly in lower lobes (80%)  Hilar adenopathy[learningradiology.com]
  • Caused by Coccidioides imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar[learningradiology.com]
  • […] chills and night sweats Fatigue Pain (headaches, sore throat, chest pain) A cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite Rattling of the chest, sometimes with dullness upon percussion over lung fields Arthralgias[dermnetnz.org]
  • Of those that do experience symptoms, the most common symptoms tend to be mild and flu-like, including: Fever Headache Cough Fatigue Chest pain Chills Shortness of breath (dyspnea) Muscle pain (myalgia) Joint pain (arthralgia) A rash will develop in around[infectiousdiseases.about.com]
Myalgia
  • Most often they have an influenza-like illness with fever , cough, headaches, rash , and myalgias (muscle pains).[medicinenet.com]
  • Illness and treatment: Symptoms can include fever, fatigue, cough, dyspnea, headache, night sweats, myalgias, and rash. Typical presentations are shortness of breath and pneumonia.[doh.wa.gov]
  • Common symptoms include fever, myalgia, arthralgia, headache, cough, and rash.[bcmj.org]
  • Of those that do experience symptoms, the most common symptoms tend to be mild and flu-like, including: Fever Headache Cough Fatigue Chest pain Chills Shortness of breath (dyspnea) Muscle pain (myalgia) Joint pain (arthralgia) A rash will develop in around[infectiousdiseases.about.com]
Joint Swelling
  • Symptoms may also include: Change in mental status Enlarged or draining lymph nodes Joint swelling More severe lung symptoms Neck stiffness Sensitivity to light Weight loss Skin lesions of valley fever are often a sign of widespread (disseminated) disease[medlineplus.gov]
  • swelling joint pain arthritis ankle, feet, and leg swelling skin lesions.[diagnose-me.com]
  • Other symptoms include chest pain, chills, night sweats, neck or shoulder stiffness, bloodtinged sputum, loss of appetite and weight loss, wheezing, change in behavior, joint swelling (ankles, feet, legs), arthritis, and light sensitivity.[encyclopedia.com]
Headache
  • Symptoms include headache, vomiting, stiff neck, and other central nervous system disturbances. A spinal tap is required for a definite diagnosis of meningitis. Clinical Images of Complications[vfce.arizona.edu]
  • If you have symptoms, they may include a flu-like illness, with fever, cough, headache, rash and muscle aches. Most people get better within several weeks or months.[icd9data.com]
  • Infection can lead to meningitis, including headache, fever, and altered mental states. Treatment with antifungal drugs usually is given for a long period of time and sometimes for life. Sometimes surgery is required to remove infected tissue.[hiv.va.gov]
  • ., Mexico, and Central America and that may be asymptomatic or present as a mild to serious flu-like illness marked chiefly by fever, cough, sore throat, headache, fatigue, and pneumonia but sometimes becoming disseminated beyond the lungs especially[merriam-webster.com]
Confusion
  • It is sometimes called valley fever but should not be confused with rift valley fever. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, a form of fungal spores.[icd9data.com]
  • Squamous cell carcinoma, halogenoderma, mycobacterial infection – The massive epidermal hyperplasia which often accompanies coccidioidomycosis my cause diagnostic confusion with these other diverse pathologic processes.[dermnetnz.org]
  • It is sometimes called valley fever but should not be confused with RIFT VALLEY FEVER. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, a form of FUNGAL SPORES.[fpnotebook.com]
  • This infection is often chronic, causing headaches, confusion, loss of balance, double vision, and other problems. Untreated meningitis is always fatal.[merckmanuals.com]

Workup

The diagnosis of coccidioidomycosis is very difficult to ascertain clinically because this fungal infection may mimic common viral infections. Chest X-ray may not even give a specific diagnosis inferring to Coccidioidomycosis. The definitive diagnosis of coccidioidomycosis falls on the demonstration of the fungus in the tissues, blood, secretions and washings from bronchoalveolar lavage [8].

The following test are done to diagnose coccidioidomycosis:

  • Sputum smear and culture: This test makes use of microscopy to demonstrate the presence of coccidioidomycosis fungus from the sputum.
  • Blood tests: Blood tests can confirm antibodies against the fungus [9].
Pulmonary Infiltrate
  • Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion.[ncbi.nlm.nih.gov]
  • Radiographic changes include a variable degree of interstitial pulmonary infiltration, hilar lymphadenopathy, and osseous lesions.[ncbi.nlm.nih.gov]
  • In these reports, the disease was invariably fatal and frequently manifested by diffuse pulmonary infiltrates [ 4 ].[doi.org]
  • All 10 persons had diffuse pulmonary infiltrates on chest radiographs; eight were hospitalized with pneumonia of unknown etiology.[cdc.gov]
Cavitary Lesion
  • Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion. The patient was treated with amphotericin B. At the time of this writing (8 months), he remains disease free.[ncbi.nlm.nih.gov]
  • Chronic pulmonary coccidioidomycosis, mainly with nodular or cavitary lesions, were often diagnosed by surgical lung biopsies.[ci.nii.ac.jp]
  • As mentioned, pleural effusion, cavitary lesions or nodules may also be seen. CT thorax if indicated. CT head scan prior to lumbar puncture (LP) if focal neurologic deficits are present.[clinicaladvisor.com]
  • Sometimes residual cavitary lesions develop; they may vary in size over time and often appear thin-walled. A small percentage of these cavities fail to close spontaneously.[msdmanuals.com]
Coccidioides Immitis
  • The Coccidioides immitis infection is caused by inhaled airborne fungal spores and it may occur as primary pulmonary (acute or chronic) asymptomatic form, meningitis, or disseminated disease.[ncbi.nlm.nih.gov]
  • Coccidioides immitis microscopy.jpg 363 466; 38 KB Coccidioides immitis on Sabouraud's medium.jpg 363 444; 44 KB Dog with Coccidioidomycosis.jpg 3.045 2.005; 6,5 MB Dog with Coccidioidomycosis.png 3.045 2.005; 13,15 MB Valley fever.png 2.005 3.045; 13,06[commons.wikimedia.org]
  • Coccidioides immitis microscopy.jpg 363 466; 38 KB Coccidioides immitis on Sabouraud's medium.jpg 363 444; 44 KB Dog with Coccidioidomycosis.jpg 3 045 2 005; 6,5 MB Dog with Coccidioidomycosis.png 3 045 2 005; 13,15 MB Valley fever.png 2 005 3 045; 13,06[commons.wikimedia.org]
  • Cultures from the aspirate revealed Coccidioides immitis confirmed by DNA probe. Pathology slides revealed fungal spores. The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling.[ncbi.nlm.nih.gov]
  • Coccidioides immitis microscopy.jpg 363 466;38キロバイト Coccidioides immitis on Sabouraud's medium.jpg 363 444;44キロバイト Dog with Coccidioidomycosis.jpg 3,045 2,005;6.5メガバイト Dog with Coccidioidomycosis.png 3,045 2,005;13.15メガバイト Valley fever.png 2,005 3,045[commons.wikimedia.org]
Pleural Effusion
  • Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes.[ncbi.nlm.nih.gov]
  • Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion.[ncbi.nlm.nih.gov]
  • Coccidioides imitus  Soil fungus endemic to Southwest (San Joaquin Valley) Primary Coccidioidomycosis  Most are asymptomatic  Clinically, may have arthralgias, skin rash  X-ray  Patchy infiltrates mainly in lower lobes (80%)  Hilar adenopathy (20%)  Pleural[learningradiology.com]
  • […] imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar adenopathy (20%) • Pleural[learningradiology.com]
  • 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]

Treatment

Coccidioidomycosis is often mild and may not require any treatment. In severe cases, symptoms are treated with increased fluid intake and adequate rest. For patients with persistent symptoms with high risk medical profile, antifungal medications like fluconazole and itraconazole in serious cases of coccidioidomycosis are used. The most serious disseminated forms of coccidioidomycosis are treated with intravenous amphotericin B [10].

Prognosis

Majority of cases of coccidioidomycosis is self-limiting and resolves completely within a few months. The use of antifungal therapy is associated with excellent prognosis. Patients who progress to chronic inflammatory phase of coccidioidomycosis with deficient cellular immunity has higher risk for intrapulmonary cavitations and extrapulmonary spread of the coccidioides infection to other organs. Poor prognosis is associated with the disseminated type of spread of coccidioides spherules which only represents 1% of all cases.

Complications

A majority of patients who inhales the coccidioides spores develop mild to moderate symptoms that may resolve spontaneously without medications. However, certain races like Filipinos, Hispanic and Asians may be at risk to develop the severe disseminated form of the infection. The following clinical conditions are common complications of coccidioidomycosis in an immune deficient hosts:

  • Severe pneumonia: This occurs when the coccidioides lung inflammation fails to resolves spontaneously and harbors other pathogens to cause the lung infection.
  • Ruptured lung nodule: A rupture lung nodule may require chest tubes to drain the trapped air or surgical repair of the lung parenchyma.
  • Disseminated disease: This refers to the most serious complication of coccidioidomycosis spreading to distant organs presenting as skin ulcers and abscess, bone lesions, arthropathies, heart inflammation, urinary tract problems, and meningitis.

Etiology

Coccidioidomycosis is caused by two genetically distinct organisms but morphologically identical soil fungus. These fungus are Coccidioides immitis and Coccidioides posadasii respectively. Both fungus are found to be endemic in the arid regions of the western hemisphere. Coccidiodes soil fungi abound regions with low elevation, scant rainfall, mild winters, hot summers, sandy alkaline soil with increase in salinity [1]. The Coccidioides immitisis is largely limited to the San Joaquin Valley; thus, coined the “valley fever”. There has been reports of zooanthropologic transmission from coccidioidomycosis infected cats to humans [2].

Epidemiology

Coccidioides are found to be endemic in the soil of the western hemisphere regions located between latitude 40 degrees north and 40 degrees south [3]. In the United States, the occurrence of C. immitis dominates the San Joaquin Valley of California while C. posadasii abounds in the desert of the southwest which includes regions of Arizona, Utah, Nevada, New Mexico and Texas.

Archeologists, farmers and construction workers are potentially at risk to coccidioidomycosis because of their frequent contact to the infected soil [4]. There is an estimated 150,000 coccidioides infections per year in the United States. The death rate approaches 75 cases per year in the US alone due to coccidioides infection.

The prevalence rate of the disease reaches 30 to 40% of the population in endemic areas like California and Arizona [5]. There are no known racial predilection for coccidioidomycosis. Older males are more prone to the infection due to occupational exposure. Coccidioides infection of the neonate rarely occurs [6].

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of coccidioidomycosis begin with the inhalation of the coccidioides spores from the soil where it is lodged in the terminal bronchioles as a C. immitis or a C. posadasii arthroconidia. Spherules are formed within the bronchioles as the arthroconidia enlarges. Hundreds to thousands of endospore offspring within the spherules rapidly divides within 48-72 hours until it is fully filled. The rupture of the endospore offspring within the bronchioles gives rise to new spherules in the pulmonary mucosa [7].

The transformation of the arthroconidia into a coccidioides spherule results into a local inflammatory process within the bronchioles causing suppuration and tissue necrosis. C. immitis has been found to trigger the complement system and release mediators of chemotaxis for neutrophils. Macrophages engulfs endospores that initiates the acute phase of the inflammation.

Chronic unabated infection with the coccidioides endospores harbors more histiocytes and lymphocytes forming a granuloma or giant cells marking the initiation of the chronic phase of inflammation in coccidioidomycosis.

Prevention

Those who are living near coccidioidomycosis endemic areas must take extra precaution especially during the summer months. One may use protective mask to prevent spore inhalation. Staying inside the house during dust storms, wetting the soil before digging, and keeping doors and windows tightly closed can prevent the fungal spores from being inhaled to the lungs.

Summary

Coccidioidomycosis or valley fever is a fungal infection characterized by coughing, fever, shortness of breath, and chest pain caused by a fungus called Coccidioides. The fungi are commonly found in the soil where it can be agitated to the air by anything that disrupts the soil such as the wind, farming, excavation, and construction.

The spores can easily be inhaled into the lungs and cause coccidioidomycosis. Mild fungal infection may spontaneously resolve without treatment while more serious infections may require antifungal medications for its resolution.

Patient Information

Definition

Coccidioidomycosis is a type of fungal infection characterized by coughing, difficulty in breathing and chest pain.

Cause

The soil fungi Coccidioides immitis and Coccidioides posadasii cause the disease.

Symptoms

Flu-like symptoms and rashes occur in acute phase, persistent symptoms may be joint pains and pneumonia in the chronic phase. Extrapulmonary involvement in disseminated coccidioidomycosis is possible.

Diagnosis

Sputum smear and culture and blood tests (fungal antibodies) are used to diagnose the condition.

Treatment and follow-up

Rest, oral antifungal and intravenous amphotericin B are the treatment options for coccidioidomycosis.

References

Article

  1. Parish JM, Blair JE. Coccidioidomycosis. Mayo Clin Proc. Mar 2008; 83(3):343-48; 348-9.
  2. Gaidici A, Saubolle MA. Transmission of coccidioidomycosis to a human via a cat bite. J Clin Microbiol. Feb 2009; 47(2):505-6.
  3. de Aguiar Cordeiro R, Brilhante RS, Rocha MF, et al. Twelve years of coccidioidomycosis in Ceara State, Northeast Brazil: epidemiologic and diagnostic aspects. Diagn Microbiol Infect Dis. 2009.
  4. CDC. from the Centers for Disease Control and Prevention. Coccidioidomycosis following the Northridge earthquake--California, 1994. JAMA. Jun 8 1994; 271(22):1735.
  5. Galgiani JN. Coccidioides Species. In: Principles and Practices of Infectious Diseases, Mandell, Douglas and Bennet. Vol 2. 6th ed. Elsevier; 2005:3040-51
  6. Hooper JE, Lu Q, Pepkowitz SH. Disseminated coccidioidomycosis in pregnancy. Arch Pathol Lab Med. Apr 2007; 131(4):652-5.
  7. Kleiman MB. Coccidioides immitis and Coccidiodes posadasii (Coccidiodomycosis). In: Long SS, Pickering LK, Prober CG. Principles and practice of pediatric infectious disease. 3rd ed. Philadelphia: Churchill Livingstone; 2008:1213-1217.
  8. Nesbit LA, Knox KS, Nguyen CT, Roesch J, Wheat LJ, Johnson SM, et al. Immunological characterization of bronchoalveolar lavage fluid in patients with acute pulmonary coccidioidomycosis. J Infect Dis. Jun 3 2013
  9. Durkin M, Connolly P, Kuberski T, et al. Diagnosis of coccidioidomycosis with use of the Coccidioides antigen enzyme immunoassay. Clin Infect Dis. Oct 15 2008; 47(8):e69-73.
  10. Galgiani JN, Ampel NM, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Practice guideline for the treatment of coccidioidomycosis. Infectious Diseases Society of America. Clin Infect Dis. Apr 2000; 30(4):658-61.

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Last updated: 2018-06-22 05:59