Coccidioidomycosis

Abstract

Coccidioidomycosis is a largely self-limited fungal respiratory illness. However, the infrequent case of progressive or disseminated disease can be devastating. As international travel to and from endemic areas increases, physicians unfamiliar with the disease may be called upon to recognize and treat serious coccidioidal infections. The major risk factors for dissemination are race and immunosuppression. The most common sites of dissemination are the skin, lymph nodes, bone and meninges. Diagnosis is aided by investigation of the patient's clinical history, delayed-type hypersensitivity skin test reaction, serologic testing, and recovery of organisms from infected tissue or secretions for direct examination and culture. Fungicidal agents are not available, fortunately, fungistatic therapy allows many patients to recover. The availability of both intravenous/intrathecal and oral agents now allows more therapeutic flexibility in the treatment of this disease.

Coccidioidomycosis in Liver Transplant Patients

“…Because of the potential severity of coccidioidomycosis in transplant patients and other immunosuppressed patients, therapy is always indicated [2,3,5,6,8,9,26,27]. Amphotericin B is still the agent most frequently used as initial therapy for coccidioidomycosis in immunosuppressed patients who have disseminated infection or are clinically unstable [2,3,5,6,8,9,[18][19][20]27].…”

“…Amphotericin B is still the agent most frequently used as initial therapy for coccidioidomycosis in immunosuppressed patients who have disseminated infection or are clinically unstable [2,3,5,6,8,9,[18][19][20]27]. The intensity and duration of therapy are determined by the severity of the disease and the subsequent clinical and serological responses [5,• 6, 6 9, 10].…”

“…Coccidioidomycosis is an illness commonly seen in residents of the southwestern United States and other warm, dry environments in the Western Hemisphere [1][2][3][4][5][6][7]. The estimated incidence of coccidioidomycosis in the United States ranges from 50,000 to 100,000 cases each year [1,3,5,6,8].…”

“…Most immunocompetent individuals who develop coccidioidomycosis remain asymptomatic or experience a relatively mild, self-limiting respiratory tract infection [2][3][4][5][6]9]. Disseminated coccidioidomycosis extending beyond the pulmonary parenchyma or hilar lymph nodes occurs in <1% of the general population [2][3][4][5][6]9].…”

“…Disseminated coccidioidomycosis extending beyond the pulmonary parenchyma or hilar lymph nodes occurs in <1% of the general population [2][3][4][5][6]9]. Although respiratory tract disease can affect any individual, disseminated coccidioidomycosis is more frequent in men, Filipinos, blacks, pregnant patients, MexicanAmericans, and immunosuppressed patients [2-6, 8, 9].…”