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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.

Cough
  • 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]
  • 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]
  • 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]
  • 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]
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]
  • […] 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]
  • 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]
  • 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-[radiopaedia.org]
Hemoptysis
  • 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]
  • Hemoptysis or the threat of rupture into the pleural space occasionally necessitates surgery.[merckmanuals.com]
  • 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) Cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite[dermnetnz.org]
  • The more common symptoms of primary infection includes : Fever Cough Chest pain Fatigue Shortness of breath Chills Sputum production Coughing up of blood (hemoptysis) Sore throat Other symptoms that may also be seen in primary coccidioidomycosis includes[healthhype.com]
  • He denied experiencing chest pain, hemoptysis, joint pain, and headache. The patient had not smoked for decades. He and his wife had no known exposure to tuberculosis, did not own any birds or other pets, and had not traveled overseas lately.[bcmj.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]
  • 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]
  • Patients who have disseminated disease present with dramatic sweats, dyspnea at rest, fever, and weight loss.[emedicine.medscape.com]
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]
  • Over the previous six months, patient had also experienced progressive weakness, shortness of breath, dry cough, and severe weight loss (60 pounds).[dx.doi.org]
Fever
  • Coccidioidomycosis, commonly called "valley fever," "San Joaquin fever," "desert fever," or "desert rheumatism," is a multi-system illness caused by infection with Coccidioides fungi (C. immitis or C. posadasii).[ncbi.nlm.nih.gov]
  • Retrospectively, the patient gave a history of Valley fever 6 years back when he was in Arizona, USA.[ncbi.nlm.nih.gov]
  • 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]
  • Coccidioidomycosis ( , kok-sid-ee-oy-doh-my- KOH -sis ), commonly known as " cocci ", [1] " Valley fever ", [1] as well as " California fever ", [2] " desert rheumatism ", [2] and " San Joaquin Valley fever ", [2] is a mammalian fungal disease caused[en.wikipedia.org]
  • 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]
Pain
  • Our case presented with several years of back pain and a pelvic mass mistaken for possible malignancy by image study.[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]
  • 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]
  • After 6 months, the initial complaints of pain and swelling were completely resolved. This case report clearly states that a travel history and culturing for fungi are helpful in patients with persisting complaints after joint arthroplasty.[ncbi.nlm.nih.gov]
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]
  • The most common clinical manifestations are chest pain, cough, fever, and fatigue 2 . In many patients, there are often associated constitutional symptoms and cutaneous manifestations such as erythema nodosum .[radiopaedia.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]
  • 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]
  • 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]
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]
  • 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]
Loss of Appetite
  • 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]
  • 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) Cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite[dermnetnz.org]
  • 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]
Parotid Swelling
  • The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling.[ncbi.nlm.nih.gov]
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]
  • Liver and spleen involvement may be demonstrated on CT as diffuse hepatosplenomegaly or focal low density parenchymal lesions. 8, 38 A radionuclide liver-spleen scan may demonstrate patchy tracer uptake in the liver.[appliedradiology.com]
Chest Pain
  • 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]
  • 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]
  • Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing.[mayoclinic.org]
  • Others will feel like they have the flu, sometimes with chest pain and a cough. Infection can lead to meningitis, including headache, fever, and altered mental states.[hiv.va.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]
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]
  • He reported being sick intermittently with a cough, fever, night sweats, myalgia, and shortness of breath for 4 weeks while traveling in Arizona.[bcmj.org]
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]
  • 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.[verywellhealth.com]
  • 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.[symptoma.com]
Eruptions
  • Reactive, immunologically mediated eruptions include erythema nodosum, a generalized exanthem, Sweet syndrome, and reactive granulomatous dermatitis.[ncbi.nlm.nih.gov]
  • 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.[verywellhealth.com]
  • Others may have a raised red rash with blisters or eruptions that look like pimples.[mayoclinic.org]
  • This eruption resembles Sweet's syndrome or a disseminated infection, with edematous and indurated cutaneous papules, nodules, and plaques presenting at the beginning of the illness.[ncbi.nlm.nih.gov]
Exanthema
  • A generalized exanthema or "toxic erythema" can occur in approximately 10 to 12% of patients with symptomatic pulmonary coccidioidomycosis and it has been reported in up to 50% to 60% of patients during outbreaks.[ncbi.nlm.nih.gov]
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, 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]
  •  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]
  • 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 Patients with more severe infections can present with additional symptoms of: Arthralgias[dermnetnz.org]
  • The constellation of fever, arthralgias, erythema nodosum or erythema multiforme, and chest pain is commonly referred to as San Joaquin Valley fever (or simply Valley fever) or desert rheumatism.[emedicine.medscape.com]
Arthritis
  • 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 B and[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]
  • […] of cases) Rarely, infected tendon sheaths demonstrating a villonodular synovitis Although arthritis is usually monoarticular, it can be migratory in nature.[emedicine.medscape.com]
  • 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]
  • […] muscle aches ( myalgia ) rash , may be painful, red, on lower legs ( erythema nodosum ) loss of appetite weight loss change in mental status sensitivity to light Additional symptoms that may be associated with this disease: joint swelling joint pain arthritis[diagnose-me.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
  • 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]
  • 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]
  • 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]
Confusion
  • Squamous cell carcinoma , halogenoderma, mycobacterial infection – The massive epidermal hyperplasia which often accompanies coccidiodomycosis 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]
  • 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.[icd10data.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].
Skin Test Positive
  • Diagnoses can be established utilizing the overall clinical picture including the probability of exposure, chest x-ray, coccidioidin skin test (positive with any prior exposure), complement fixation studies, and measurement of IgM and IgG antibodies to[dx.doi.org]
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]
  • 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]
  • Thin- or thick-walled cavitary lesions, most of which are identified in the upper lungs, may develop from excavation of consolidation or nodules.[appliedradiology.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.[merckmanuals.com]
Pulmonary Infiltrate
  • Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion.[ncbi.nlm.nih.gov]
  • Despite antifungal therapy his pulmonary status worsened with progressive bilateral pulmonary infiltrates and worsening hypoxemic respiratory failure (Figure 3). Figure 3.[swjpcc.com]
  • Diffuse bilateral pulmonary infiltrates may be a result of a hematogenous spread. They may also be a result of a multiple foci of infection secondary to high innoculum exposure.[bmcinfectdis.biomedcentral.com]
  • As the patient's illness improves, either with or without antifungal therapy, continued monitoring at 13-month intervals for 1 year or longer is advised to assess the resolution of pulmonary infiltrates and to identify, as early as possible, those patients[academic.oup.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]
  • 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]
  • immitis (disorder) , Infection by Coccidioides immitis , Coccidioidomycosis NOS , Coccidioidomycosis [Disease/Finding] , Coccidioides immitis Infection , Coccidioides immitis Infections , Valley Fevers , Valley Fever , Infection, Coccidioides immitis[fpnotebook.com]
  • This disease should enter in the differential diagnosis of any febrile patient (especially if presenting with pulmonary symptoms, with or without hypereosinophilia) coming from Coccidioides immitis endemic areas.[ncbi.nlm.nih.gov]
Granulomatous Tissue
  • Even though the mainstay of treatment for Sweet's syndrome are corticosteroids, they are not recommended in the setting of coccidioidal infection, since they could exacerbate the condition. 60 INTERSTITIAL GRANULOMATOUS DERMATITIS Granulomatous tissue[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]
  • […] 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]
  • 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]
  • 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-[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