Coccidioidomycosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Coccidioidomycosis is a fungal disease caused by Coccidioides immitis or C. posadasii.[1] It can be caused by breathing coccidioides spores in the air, especially after a soil disturbance. As per CDC [3] about 30-60 % people living in endemic areas are exposed to the infection sometimes in their lives.
Historical Perspective
Coccidioidomycosis was first discovered for the time in 1892 by, Alejandro Posadas (a medical student) along with his mentor and they grouped coccidioidomycosis under parasitic family. Emmet Rixford and T. Caspar Gilchrist coined the term coccidioidomycosis (resembling Coccidia) in 1896. William Ophüls and Herbert C. Moffitt described its dimorphic nature and defined it as a fungal etiology in 1900. C. immitis was investigated by the United States during the 1950s and 1960s as a potential biological weapon. It was never standardized, around beyond a few field trials, it was never weaponized.
Pathophysiology
Coccidioidomycosis is a fungal infection, that is acquired through inhalation of the spores that is present in the environment. 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.[2][3][4][5]
Causes
Coccidioides immitis and Coccidioides posadasii
Epidemiology and Demographics
California state prisons have been particularly affected by Coccidioidomycosis, as far back as 1919. In 2005 and 2006, the Pleasant Valley State Prison near Coalinga and Avenal State Prison near Avenal on the western side of the San Joaquin Valley had the highest incidence rate in 2005, of at least 3,000 per 100,000. It is endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah and northwestern Mexico.
Differentiating Coccidioidomycosis from other Diseases
Coccidioidomycosis presents as a mild flu-like illness that needs to be differentiated from a number of other fungal/bacterial disorders. These disorders have overlapping signs & symptoms that often need detailed History, Physical examination and serological tests to pin-point the diagnosis. Blastomycosis, Histoplasmosis, Aspergillosis, Pneumocystis pneumonia, Sporotrichosis
Risk Factors
On occasion, those particularly susceptible, including pregnant women, people with weakened immune systems, and those of Asian, Hispanic and African descent, may develop a serious or even fatal illness from valley fever.
Naturall History, Complications and Prognosis
Natural History
Symptomatic infection (40% of cases) usually presents as an influenza-like illness with fever, cough, headaches, rash, and myalgia (muscle pain).[6] Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting meninges, soft tissues, joints, and bone). Severe pulmonary disease may develop in HIV-infected persons.[7]
Complications
Serious complications include severe pneumonia, lung nodules, and disseminated disease, where the fungus spreads throughout the body. The disseminated form of valley fever can devastate the body, causing skin ulcers and abscesses to bone lesions, severe joint pain, heart inflammation, urinary tract problems, meningitis, and death.
Prognosis
The prognosis of Coccidioidomycosis is good in immunocompetent patients. It is self-limited in most of the patients and recovery is without any complications. The mortality rate is currently <0.07%. Approximately less than 1 % of patients develop disseminated coccidioidomycosis.
Diagnosis
Symptoms
The disease is usually mild, with flu-like symptoms and rashes.
Laboratory Findings
The fungal infection can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and biopsy-tissue. With specific nucleotide primers C.immitis DNA can be amplified by PCR. It can also be detected in culture by morphological identification or by using molecular probes that hybridize with C.immitis RNA. An indirect demonstration of fungal infection can be achieved also by serologic analysis detecting fungal antigen or host antibody produced against the fungus.
References
- ↑ Walsh TJ, Dixon DM (1996). Spectrum of Mycoses. In: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
- ↑ 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.
- ↑ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. pp. 680-83. ISBN 0838585299.
- ↑ Ampel N (2005). "Coccidioidomycosis in persons infected with HIV type 1". Clin Infect Dis. 41 (8): 1174–8. PMID 16163637.