Coccidioidomycosis: Changing Perceptions and Creating Opportunities for Its Control

Abstract

The perceptions of coccidioidomycosis as a medical problem has undergone sequential and dramatic metamorphoses since its first description more than a century ago. First thought to be rare and lethal, coccidioidomycosis was subsequently found to be common and often mild. During World War II, its overall impact upon large populations came sharply into focus and the consequences for public health became clearer. Early treatments had significant limitations and toxicities, and therefore treatment of coccidioidomycosis was reserved for only the sickest patients. Since then, safer oral therapies have become commonplace. Despite their availability, there has been no investigation of their use in the less severe and much more common early infections. Even newer drugs such as nikkomycin Z, which might actually cure infections, until very recently have had trouble finding a sponsor to move it through clinical trials. Perceptions once formed by the understanding of coccidioidomycosis as a medical problem now appear to hinder the future study of newer therapeutic opportunities. It is suggested in this review that it is time to revisit and possibly change these perceptions if we are to improve our care of patients.

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

“…The consequences of infection range from an inconsequential illness with resulting lifelong resistance to reinfection to severe and potentially life-threatening pneumonia or tissue destruction throughout the body. Several reviews have summarized the historical evolution of our understanding of coccidioidomycosis (1)(2)(3). Others have dealt with immunologic studies of experimental infections, primarily in mice (4,5).…”

Valley fever: danger lurking in a dust cloud

“…During a six-month period of WWII, as many as 50% of military personnel in Arizona undergoing the coccidioidomycosis skin test showed evidence of infection. At that time, Germany protested that exposure of its prisoners of war to the fungus in work camps violated the Geneva Convention [22]. In recent years, the incidence of coccidioidomycosis has increased in the elderly, even when the increase is adjusted for age [12].…”

The poetry of mycological accomplishment and challenge

“…11 e Models of (a) the ancestral and widespread Woronin body in Pezizomycotina, of (b) the evolution of a single ancestral leashin molecule to the two leashins, LAH1 and LAH2, found in Neurospora, and of (c) the Woronin body and leashins in Neurospora. to infect humans with a potentially fatal disease (Galgiani, 2007;Pappagianis, 1988). The closely related genus Uncinocarpus is also associated with small mammals, but does not cause a human disease and the more distantly related fungi, Neurospora, Aspergillus and the others, are similarly benign for healthy humans and lack a close association with mammals.…”