Coccidioidomycosis is clinical disease resulting from fungal infection by either Coccidioides immitis or Coccidioides posadasii. The organism is endemic in the Americas 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.
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.
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.
Usually reserved for disseminated coccidioidomycosis or severe respiratory disease. Response can be with:
In refractory disease:
- ↑ Brown J, Benedict K, Park BJ, Thompson GR. Coccidioidomycosis: epidemiology. Clinical epidemiology. 2013; 5:185-97.(Epub) (Link to article – subscription may be required.)
- ↑ Increase in reported coccidioidomycosis--United States, 1998-2011. MMWR. Morbidity and mortality weekly report. 2013 Mar 29; 62(12):217-21.
- ↑ Levy ER, McCarty JM, Shane AL, Weintrub PS. Treatment of pediatric refractory coccidioidomycosis with combination voriconazole and caspofungin: a retrospective case series. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2013 Jun; 56(11):1573-8.(Link to article – subscription may be required.)