Coccidioidomycosis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]

Pathogenesis

The pathogenesis of coccidiodomycosis can be described in following steps.

Transmission

• Coccidioiodomycosis exist as mycelia in the soil with septations.
• During hot climate or dry environment, they proliferate asexually, transforming into spores, known as arthroconidia.
• Infection is caused by inhalation of these arthroconidia. The disease is not transmitted from person to person.

Incubation period

• Incubation period of coccidioidomycosis varies from one to three weeks.

Dissemination

• Following transmission, coccidioidomycosis are deposited into terminal bronchioles and enlarge, become rounded and develop internal septations to form what are known as the spherules.
• It then disseminates to the lymphatics and blood stream to gain access to any organ of the body.

Seeding

• Spherules contain uni-nuclear cells called as endospores which may propagate the infection further as they have the capability to develop into spherules.
• This conversion of anthroconidia into spherules initiates an inflammatory reaction and leads to a chemotaxic response (peptides derived from activation of the complement pathway, leukotrienes ) which attracts neutrophils and eosinophils to the site of inflammation.
• Cell mediated immunity keeps the infection in check and keeps them limited to the organ of origin by forming granulomas.

Immune response

Coccidioidomycosis elicits cell-mediated immune responses.

• Delayed type hypersensitivity to coccidioidal antigens is common after acute infection has resolved.
• Dissemination usually occurs via the lymphatics and is more common in immune suppressed in whom the primary infection is not contained.

Life cycle of coccidiodes

Genetics

There is no known genetic association to coccidioidomycosis.

Microscopic pathology

Microscopic Pathology

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