COCCIDIOIDOMYCOSIS
A fungal infection cause – inhalation of arthroconidia of Coccidioides immitis or C posadasii, organisms are molds that grow in soil in endemic area.
Incubation period of 10–30 days.
May cause mild infection- influenza-like illness, fever, backache, headache, fatigue to severe disseminated disease & may death.
COCCIDIOIDOMYCOSIS– Symptoms and Signs:
Acute infection- often asymptomatic, some with acute pneumonia (17%-29% cases of community-acquired pneumonia.
Fever, cough, and fatigue and lasts about 3 weeks.
Rash or skin nodules may be seen in up to half of patients
Erythema nodosum may be seen 2–20 days after symptoms occurs
Persistent pulmonary lesions, vary from cavities, abscesses to parenchymal nodular densities or bronchiectasis ~5% patients.
Disseminated disease (0.1 to 1%)- Any organ may involve.
Pulmonary findings- cough, and increased sputum production, mediastinal lymph node enlargement.
Lung abscesses rupture into pleural space, leads to empyema.
Complicated skin, bone and joint manifestations like synovitis and osteomyelitis.
Fungemia- diffuse miliary pattern on chest X-ray, & early death, rapid in immunosuppressed cases
Meningitis occurs in 30–50%
Subcutaneous abscesses and verrucous skin lesions- common in fulminating cases
COCCIDIOIDOMYCOSIS– Investigations:
Primary coccidioidomycosis- moderate leukocytosis, eosinophilia.
microscopic examination of blood or body fluid- show endospore-containing spherules.
fungal culture.
Blood culture rarely positive.
Serologic test for diagnosis and prognosis.
IgM antibodies- detectable about 1-3 weeks after disease onset & indicates acute infection
Persistently rising “IgG (detectable 2-3 weeks after disease onset)” complement fixation titer (1:16 or more)- suggests increased infectious activity & disseminated disease.
Spinal fluid- increased cell count with lymphocytosis & reduced glucose.
Spinal fluid culture is positive ~ 30% of meningitis.
In spinal fluid complement-fixing antibodies (>90%) are diagnostic of coccidioidal meningitis.
Coccidioides antigen or (1,3)-beta-D-glucan may augment CSF antibody testing.
Antigen detection- useful in immunocompromised cases, they may not develop antibody response
X- ray Chest- most common findings are patchy, nodular, and lobar, upper lobe pulmonary infiltrates. Hilar lymphadenopathy localized disease. mediastinal lymphadenopathy suggesting dissemination. Pleural effusions and lytic lesions in bone with accompanying complicated soft tissue collections may be seen.
COCCIDIOIDOMYCOSIS– Treatment:
Itraconazole oral 200 mg BD or Fluconazole 200–400 mg oral, for disease of chest, bones, & soft tissues; treatment continue for >/= 6 months after the disease is inactive to prevent relapse.
Intravenous liposomal amphotericin B for progressive pulmonary or extrapulmonary disease.
Meningitis- high-dose oral fluconazole 400– 1200 mg/day.
Surgical drainage is necessary in treatment of soft tissue abscesses, necrotic bone, & complicated pulmonary disease.
An extended follow-up ≥ 1 year is needed in complicated disease.
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