To identify possible explanations for the resistance of Coccidioides immitis to killing by human neutrophils, its susceptibility to typical oxidants generated during the neutrophil respiratory burst was compared to the sensitivity of other microbes. When microbial suspensions were exposed to hypochlorous acid, arthroconidia or spherules of C. immitis were killed more slowly than yeast cells of Candida (Torulopsis) glabmta or Staphylococcus aureus. In contrast, exposure to the more lipophilic oxidant, monochloramine, produced equivalent rates of killing for spherules and yeast cells of C. glabrata, and arthroconidia were killed more rapidly. When larger microbial concentrations were used, significantly greater concentrations of hypochlorous acid were required to kill equivalent percentages of spherules as compared to yeast cells of C. glabrata. Mixing studies with either whole spherules or extracts of spherules demonstrated that these substances could also block hypochlorous acid killing of S. aureus. These studies suggest possible mechanisms whereby C. immitis might resist oxidative phagocytic killing.
Coccidioidomycosis, when contracted by otherwise healthy persons, is typically a self-limited infection [13, 23]. The critical host defense responsible for resolution of the illness is believed to be T lymphocyte-dependent cytokine-mediated activation of tissue macrophages analogous to control mechanisms identified in experimental studies of murine infection [2-5]. However, various clinical observations stronglysuggest that control may not require lethal eradication of the fungus in humans. These include the high frequency of recovery of Coccidioides imrnitis from surgically resected quiescent pulmonary nodules [30], chronic asymptomatic excretion of C. immitis in certain patients from pulmonary cavities or prostatic foci [9, 40], and the recrudescence of infection in immunocompromized patients [6, 10, 38] many years after the initial exposure and often far from the endemic area. Furthermore, we and others have noted the striking resistance of C. immitis to the normally microbicidal effect of human neutrophils [ 15, 16, 19]. The reasons for this failure of neutrophil killing have not been readily apparent since other observations have indicated that neutrophils are