Coccidioidomycosis

Abstract

The difficulties in managing this potentially horrific disease, with its myriad manifestations, are immense, because host factors dramatically impact outcome. Coccidioidomycosis should warrant great respect among clinicians, because, even with dramatic improvements in therapies, outcomes remain poor. Although there have been outstanding successes with these new therapies, tragic losses after years of immense patient suffering still occur. Coccidioidomycosis is a geographically restricted fungus but is one that inflicts tremendous suffering on affected patients. In addition, because of travel and the influx of susceptible hosts, dramatic increases in patients at risk for infection are seen throughout the southwest United States. The extended-spectrum azoles, such as posaconazole and voriconazole, may prove to be more efficacious in the treatment of coccidioidomycosis than prior agents, including amphotericin B, fluconazole, and itraconazole. Additional resources are needed to conduct randomised, controlled clinical trials for the treatment of this disease.

Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children

“…The diagnosis of coccidioidomycosis is based on clinical suspicion supported by a combination of microbiologic, histopathologic, immunologic or radiographic evidence 49 . Culture is the most definitive diagnostic method, and while the organism grows readily in about 5-7 days, it is extremely dangerous in the laboratory and handled using Biosafety Level 3 containment 56 .…”

“…IgM antibody can be detected within the first few weeks of infection using immunodiffusion with the tube precipitin antigen assay. Immunodiffusion complement-fixation antibody testing measures IgG antibodies to complement-fixing antigen, and usually becomes positive after several months of infection 49 . The antibody titer can be correlated with the extent of disease, with elevated titers typically being associated with progressive disease 58,59 , however studies have shown that elevated serum titers may persist after clinical resolution 60 .…”

Coccidioidomycosis in African Americans

“…23 Symptoms usually begin 1 to 3 weeks after inhaling arthroconidia. 19 Patients with primary pulmonary coccidioidomycosis can have acute or subacute features of a flulike illness or progressive pneumonia. The symptoms may be indistinguishable from those of community-acquired pneumonia, and the disease may occur with any combination of the following: fever, cough, dyspnea, chest pain, weight loss, fatigue, or headache.…”

Coccidioidal Pneumonia, Phoenix, Arizona, USA, 2000–2004

“…When soil is disrupted, airborne arthroconidia can be inhaled, causing infections in humans and animals. These infections can be asymptomatic or can produce illness of varying severity, from mild, self-limited respiratory infection to severe, life-threatening pneumonia (2). In a small percentage of patients, Coccidioides spp.…”

“…In a small percentage of patients, Coccidioides spp. may spread beyond the pulmonary tract, most frequently to the cutaneous, osteoarticular, or central nervous systems (2).…”