Coccidioidomycosis

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Coccidioidomycosis is clinical disease resulting from fungal infection by either Coccidioides immitis or Coccidioides posadasii. The organism is endemic in the Americas[1] and is sometimes known as San Joaquin Valley fever. This is because of the local environment and the condition in such local high risk environments is probably as common as when first recognised as an issue there in the 1896. Actually it had been described by Dr. Alejandro Posadas in Buenos Aires in 1892 but not fully understood as more than a skin parasite. Coccidioides exists in the environment, thriving in the soil, but assumes a dormant spore stage in dry conditions. These can be released in to the air during construction, excavation, earthquake, or shaking out dusty clothes. The air borne spores are inhaled such that respiratory disease is the commonest presentation.

A single Coccidioides organism within a granuloma.

In immunocompetent individuals, the primary respiratory infection ("primary respiratory coccidioidomycosis") may be asymptomatic (2 thirds) or subclinical. Others will develop symptoms indistinguishable from other common respiratory tract infections and will recover with no complications. A more severe disease may occur in immunosuppressed individuals with systemic infection (disseminated coccidioidomycosis), e.g. in HIV/AIDS, pregnancy.

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  • Incidence in California and Arizona has been increasing since about 2005[2]
  • Presentation could be anywhere in the world - patients have presented after short stop overs at Phoenix airport.
  • Infections in German prisoners of war held in Arizonia lead to a request for the prisoners to be moved to a safer environment.
  • An outbreak occurred in Ventura County after the 1994 earthquake in Northridge, Los Angeles
  • Ten Navy Seals were infected during training exercises in Coalinga, California in 2001.
Lung nodule. The pale areas on the left are necrotic
Coccidioides organisms.

In about 5% of individuals, the organism is not cleared and can develop into lung nodules, with cavitation and possible progression into chronic respiratory coccidioidomycosis. The disease can also become systemic, with certain ethnic groups showing particular susceptibility.

Treatment

Usually reserved for disseminated coccidioidomycosis or severe respiratory disease. Response can be with:

In refractory disease:

References

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