Coccidioidomycosis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Coccidioidomycosis}} | {{Coccidioidomycosis}} | ||
{{CMG}}; {{AE}}; {{VB}}; {{ADG}} | |||
{{CMG}}; {{AE}}; {{VB}} | ==Overview== | ||
The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are [[Lungs|lungs,]] [[skin]], [[bones]], [[genitourinary system]], [[central nervous system]] and other organs.<ref name="pmid26739609">{{cite journal |vauthors=Stockamp NW, Thompson GR |title=Coccidioidomycosis |journal=Infect. Dis. Clin. North Am. |volume=30 |issue=1 |pages=229–46 |year=2016 |pmid=26739609 |doi=10.1016/j.idc.2015.10.008 |url=}}</ref><ref name="pmid26398540">{{cite journal |vauthors=Twarog M, Thompson GR |title=Coccidioidomycosis: Recent Updates |journal=Semin Respir Crit Care Med |volume=36 |issue=5 |pages=746–55 |year=2015 |pmid=26398540 |doi=10.1055/s-0035-1562900 |url=}}</ref><ref name="pmid25577855">{{cite journal |vauthors=DiCaudo DJ |title=Coccidioidomycosis |journal=Semin Cutan Med Surg |volume=33 |issue=3 |pages=140–5 |year=2014 |pmid=25577855 |doi= |url=}}</ref><ref name="pmid24575994">{{cite journal |vauthors=Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS |title=Update on the diagnosis of pulmonary coccidioidomycosis |journal=Ann Am Thorac Soc |volume=11 |issue=2 |pages=243–53 |year=2014 |pmid=24575994 |doi=10.1513/AnnalsATS.201308-286FR |url=}}</ref> | |||
==Physical Examination== | ==Physical Examination== | ||
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===HEENT=== | ===HEENT=== | ||
[[Photophobia]], [[episcleritis]], [[conjunctivitis]], [[scleritis]] | |||
===Lymph nodes=== | ===Lymph nodes=== | ||
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*[[Percussion of the lungs|Dullness to percussion]] | *[[Percussion of the lungs|Dullness to percussion]] | ||
*Increased [[fremitus]] | *Increased [[fremitus]] | ||
*[[Bronchial breathing]]. | *[[Lung sounds|Bronchial breathing]]. | ||
*[[Rales]] & [[Ronchi]] | *[[Rales]] & [[Ronchi]] | ||
===Abdominal=== | ===Abdominal=== | ||
*Abdomen soft and non-distended with no scars or striations | *[[Abdomen]] soft and non-distended with no [[Scar|scars]] or striations | ||
*No pulsatile masses or [[Abdominal bruit|abdominal bruits]] | *No pulsatile [[Mass|masses]] or [[Abdominal bruit|abdominal bruits]] auscultated | ||
*[[Spleen]] not palpable, [[liver]] not palpable | *[[Spleen]] not palpable, [[liver]] not palpable | ||
===Skin=== | ===Skin=== | ||
*Erythema nodosum | *[[Erythema nodosum]] ( It presents as tender red [[nodules]] on the shins that are smooth and shiny) | ||
*[[Erythema multiforme]]( classical "target lesion" appearance, with a pink-red ring around a pale center) | |||
*Verrucous lesions with irregular border and variegated appearance | *Verrucous lesions with irregular border and variegated appearance | ||
[[Image:Erythema-nodosum.jpg|500px|center|]] | [[Image:Erythema-nodosum.jpg|500px|center|]] | ||
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===Bone and joints=== | ===Bone and joints=== | ||
*Soft tissue swelling around the area of involvement and discharging sinuses might be consistent with [[osteomyelitis]]. | *Soft [[tissue]] [[swelling]] around the area of involvement and discharging [[sinuses]] might be consistent with [[osteomyelitis]]. | ||
*[[Arthritis]] can cause reproducible pain in joints. | *[[Arthritis]] can cause reproducible [[pain]] in [[joints]]. | ||
===Genitourinary system=== | ===Genitourinary system=== | ||
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*[[Ulcers]] that bleed on touch | *[[Ulcers]] that bleed on touch | ||
===Neurological=== | ===Neurological=== | ||
Normal examination | Normal examination findings are seen unless the [[infection]] is disseminated to the brain resulting in [[meningitis]], findings of [[neural]] involvement include: | ||
*[[Consciousness|Altered level of consciousness]] | *[[Consciousness|Altered level of consciousness]] | ||
*[[Nuchal rigidity]] | *[[Nuchal rigidity]] | ||
*Increased intracranial pressure is a common finding | *[[Increased intracranial pressure]] is a most common finding when [[meninges]] are involved. | ||
==Gallery== | ==Gallery== | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Fungal diseases]] | [[Category:Fungal diseases]] | ||
[[Category:Biological weapons]] | [[Category:Biological weapons]] | ||
[[Category:Disease]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 21:00, 29 July 2020
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Coccidioidomycosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Coccidioidomycosis physical examination On the Web |
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American Roentgen Ray Society Images of Coccidioidomycosis physical examination |
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Risk calculators and risk factors for Coccidioidomycosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]; Aditya Ganti M.B.B.S. [3]
Overview
The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are lungs, skin, bones, genitourinary system, central nervous system and other organs.[1][2][3][4]
Physical Examination
Vital Signs
HEENT
Photophobia, episcleritis, conjunctivitis, scleritis
Lymph nodes
- In cases with skin involvement from direct inoculation, regional lymph node enlargement may be seen.
Neck
- No masses
Cardiovascular system
- Regular rate and rhythm
- Normal S1, S2
- No murmurs, rubs, or gallops
Lungs
Findings consistent with parenchymal consolidation such as[5]
- Dullness to percussion
- Increased fremitus
- Bronchial breathing.
- Rales & Ronchi
Abdominal
- Abdomen soft and non-distended with no scars or striations
- No pulsatile masses or abdominal bruits auscultated
- Spleen not palpable, liver not palpable
Skin
- Erythema nodosum ( It presents as tender red nodules on the shins that are smooth and shiny)
- Erythema multiforme( classical "target lesion" appearance, with a pink-red ring around a pale center)
- Verrucous lesions with irregular border and variegated appearance
Bone and joints
- Soft tissue swelling around the area of involvement and discharging sinuses might be consistent with osteomyelitis.
- Arthritis can cause reproducible pain in joints.
Genitourinary system
Extremities
- Ulcers that bleed on touch
Neurological
Normal examination findings are seen unless the infection is disseminated to the brain resulting in meningitis, findings of neural involvement include:
- Altered level of consciousness
- Nuchal rigidity
- Increased intracranial pressure is a most common finding when meninges are involved.
Gallery
-
![Erythema nodosum lesions on skin of back due to hypersensitivity to antigens of Coccidioides immitis. From Public Health Image Library (PHIL). [6]](/images/b/b2/Coccidioidomycosis28.jpeg)
Erythema nodosum lesions on skin of back due to hypersensitivity to antigens of Coccidioides immitis. From Public Health Image Library (PHIL). [6] -
![Chronic lesion that had been determined to be due to a Coccidioides sp. fungal infection. From Public Health Image Library (PHIL). [6]](/images/3/32/Coccidioidomycosis03.jpeg)
Chronic lesion that had been determined to be due to a Coccidioides sp. fungal infection. From Public Health Image Library (PHIL). [6] -
![Large red spot formed at volar surface of patient's left arm, indicating a positive result to a skin test to determine whether patient was exposed to the Coccidioides spp. fungal organism. From Public Health Image Library (PHIL). [6]](/images/f/f7/Coccidioidomycosis01.jpeg)
Large red spot formed at volar surface of patient's left arm, indicating a positive result to a skin test to determine whether patient was exposed to the Coccidioides spp. fungal organism. From Public Health Image Library (PHIL). [6]
![Erythema nodosum lesions on skin of back due to hypersensitivity to antigens of Coccidioides immitis. From Public Health Image Library (PHIL). [6]](/index.php/File:Coccidioidomycosis28.jpeg)
![Chronic lesion that had been determined to be due to a Coccidioides sp. fungal infection. From Public Health Image Library (PHIL). [6]](/index.php/File:Coccidioidomycosis03.jpeg)
![Large red spot formed at volar surface of patient's left arm, indicating a positive result to a skin test to determine whether patient was exposed to the Coccidioides spp. fungal organism. From Public Health Image Library (PHIL). [6]](/index.php/File:Coccidioidomycosis01.jpeg)
References
- ↑ Stockamp NW, Thompson GR (2016). "Coccidioidomycosis". Infect. Dis. Clin. North Am. 30 (1): 229–46. doi:10.1016/j.idc.2015.10.008. PMID 26739609.
- ↑ Twarog M, Thompson GR (2015). "Coccidioidomycosis: Recent Updates". Semin Respir Crit Care Med. 36 (5): 746–55. doi:10.1055/s-0035-1562900. PMID 26398540.
- ↑ DiCaudo DJ (2014). "Coccidioidomycosis". Semin Cutan Med Surg. 33 (3): 140–5. PMID 25577855.
- ↑ Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS (2014). "Update on the diagnosis of pulmonary coccidioidomycosis". Ann Am Thorac Soc. 11 (2): 243–53. doi:10.1513/AnnalsATS.201308-286FR. PMID 24575994.
- ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
- ↑ 6.0 6.1 6.2 "Public Health Image Library (PHIL)".