Coccidioidomycosis physical examination: Difference between revisions

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{{CMG}}; {{AE}}; {{VB}}
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==Physical Findings==
==Physical Examination==
===Vital Signs===
*[[Fever]] <ref name="pmid26398538">{{cite journal |vauthors=Smith JA, Gauthier G |title=New Developments in Blastomycosis |journal=Semin Respir Crit Care Med |volume=36 |issue=5 |pages=715–28 |year=2015 |pmid=26398538 |doi=10.1055/s-0035-1562898 |url=}}</ref>
*[[Tachypnea]]


There are no pathognomic signs for Coccidioidomycosis, however numerous findings are observed depending on the organ system involved. Features suggestive of disseminated disease include: profuse sweating, dyspnea, high grade fever and weight loss. The various organ systems involved are.  
===Oral cavity===
*[[Oral ulcers]] can be seen in some patients
===Lymph nodes===
*In cases with [[skin]] involvement from direct [[inoculation]], regiona[[Lymphadenopathy|l lymph node enlargement]] may be seen.
===Neck===
*No masses
===Cardiovascular system===
*Regular rate and rhythm
*[[Heart sounds|Normal S1, S2]]
*No [[murmurs]], rubs, or [[Gallops and Extra Heart Sounds|gallops]]
===Lungs===
Findings consistent with [[Consolidation (medicine)|parenchymal consolidation]] such as<ref>{{cite book | last = Kauffman | first = Carol | title = Essentials of clinical mycology | publisher = Springer | location = New York | year = 2011 | isbn = 978-1-4419-6639-1 }}</ref>
*[[Percussion of the lungs|Dullness to percussion]]
*Increased [[fremitus]]
*Signs of pleura involvement such as pleuritic rub.
===Abdominal===
*Abdomen soft and non-distended with no scars or striations
*No pulsatile masses or [[Abdominal bruit|abdominal bruits]] ascultated
*[[Spleen]] not palpable, [[liver]] not palpable


====Respiratory system====
===Skin===


* [[Bronchial breathing]].
*Ulcerative lesions that bleed easily
* [[Rales]] & [[Ronchi]]
*Verrucous lesions with irregular border and variegated appearance
* Areas of consolidation with resultant dullness to percussion , and increased tactile and vocal fremitus. 
* 5-10% cases may develop pulmonary nodules which may resolve spontaneously or may ulcerate and cause [[hemoptysis]].


====Skin manifestations====
===Bone and joints===
[[Image:Erythema-nodosum.jpg|200px]]


*Soft tissue swelling around the area of involvement and discharging sinuses might be consistent with [[osteomyelitis]].
*[[Arthritis]] can cause reproducible pain in joints.


[[Erythema nodosum]] presenting as tender, erythematous nodules, about 1-2 cm in size are classic in endemic areas. Theses are more frequently found on the anterior surface of lower extremities but are also seen on upper extremities. Erythema multiforme occuring around the neck in necklace like pattern is also seen.
===Genitourinary system===


Ocular hypersensitivity is a frequent finding presenting as episcleritis, conjunctivitis, sclerities. Cutaneous hypersensitivity sometimes occur, and is suggestive of a trend towards resolution of symptoms, however needs to be differentiated from cutaneous involvement which is a bad prognostic sign.
*[[Pyuria]]
classical skin manifestation of coccidioidomycosis is a verrucous granuloma at the nasolabial fold, but other morphological appearances such as plaques and pustules are also found.
*[[Dysuria|Painful urination]]


====Meningitis====
===Extremities===
*[[Ulcers]] that bleed on touch
===Neurological===
Normal examination finding unless the infection is disseminated to brain resulting in meningitis,then findings include :
*[[Consciousness|Altered level of consciousness]]
*[[Nuchal rigidity]]


Meningitis associated with coccidioidomycosis is usually more chronic in onset then acute and is a result of disseminated infection. It is a serious condition and may result in death. Symptoms of meningitis are more common and obvious, while other symptoms such as focal deficits and cranial nerve palsies are much less common. Increased intracranial pressure is a common finding and is often symptomatic. Untreated disease is uniformly fatal.
=====Gallery=====


====Musculoskeletal manifestations====
<gallery>


It can present with a monoarticular arthritis which may sometimes be migratory, knees are the most commonly affected joint. scleroic or lytic bone lesions are also seen but are not as common as in blastomycosis. Joint involvement resulting in [[synovitis]] is observed but aspiration of synovial fluid does not give specific findings. Osteomyelitis from hematogenous spread and from direct inoculation can lead to chronic infections, which may ulcerate to surface to cause draining fistulas. Paraspinal abscesses can occur from contiguous spread and may need surgical decompression to relieve cord compression.  
Image: Blastomycosis08.jpeg| Morphologic changes that took place upon a patient’s arm, which included keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


====Other organ systems====
Image: Blastomycosis09.jpeg| Morphologic changes that took place upon a patient’s arm, which included keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Almost all other organs can be involved as well but the chances are minimal. The total percent of cases with dissemination are close to 1%.In people with HIV and other immuno-compromised diseases septic shock and fungemia may occur.
Image: Blastomycosis11.jpeg|Patient’s right knee revealed the keloidal scarring brought on due to a case of cutaneous blastomycosis, which was caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
Image: Blastomycosis13.jpeg| Patient’s right knee revealed the keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
Image: Blastomycosis15.jpeg|Patient’s right ankle displayed keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
</gallery>


==Gallery==
==Gallery==

Revision as of 18:08, 10 March 2017

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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]

Physical Examination

Vital Signs

Oral cavity

Lymph nodes

Neck

  • No masses

Cardiovascular system

Lungs

Findings consistent with parenchymal consolidation such as[2]

Abdominal

  • Abdomen soft and non-distended with no scars or striations
  • No pulsatile masses or abdominal bruits ascultated
  • Spleen not palpable, liver not palpable

Skin

  • Ulcerative lesions that bleed easily
  • 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

Neurological

Normal examination finding unless the infection is disseminated to brain resulting in meningitis,then findings include :

Gallery

Gallery

References

  1. ↑ Smith JA, Gauthier G (2015). "New Developments in Blastomycosis". Semin Respir Crit Care Med. 36 (5): 715–28. doi:10.1055/s-0035-1562898. PMID 26398538.
  2. ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "Public Health Image Library (PHIL)".

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