Coccidioidomycosis - acute pulmonary
Key points
- Coccidioidomycosis is an infection caused by inhalation of spores of Coccidioides immitis, a fungus found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.
- Coccidioides infection begins in the lungs, following inhalation of the spores.
- The acute disease is almost always benign and goes away without treatment.
- Disseminated coccidioidomycosis can be serious, particularly in people with weakened immune systems.
Definition
Coccidioidomycosis is an infection caused by inhalation of spores of Coccidioides immitis, a fungus found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.
Causes, incidence, and risk factors
Coccidioides infection begins in the lungs, following inhalation of the spores. About 60% of infections resolve without ever causing symptoms and are only recognized by a positive coccidioidin skin test.
In the remaining 40% of infections, symptoms range from mild (cold-like or flu-like) to severe (pneumonia). (See coccidioidomycosis.) In less than 1% of infections, widespread disease occurs when the fungus spreads from the lungs through the blood stream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.
Individuals of African or Philippine descent, and people with weakened immune systems due to AIDS, diabetes, or immunosuppressive medications, may develop more serious infections. Occasionally the acute infection may develop into a chronic pulmonary (lung) disease or can reactivate after a long latent period.
A history of travel to an endemic region is the key to suspecting coccidioidal infection. Arizona, California (especially San Joaquin Valley), and - to a lesser extent - western Texas, are endemic regions in the USA.
Symptoms
- Cough
- Sputum or phlegm
- Chest pain, varies from mild sense of constriction to severe
- Fever
- Chills
- Night sweats
- Headache
- Muscle stiffness
- Muscle aches
- Joint stiffness
- Rash, may be painful, red, on lower legs (erythema nodosum)
- Weight loss
- Lymph node swelling
Signs and tests
- Sputum smear (KOH test or Papanicolaou stain)
- Bronchoscopy with lavage
- Biopsy of lymph node or lung (often done with bronchoscopy)
Treatment
The acute disease is almost always benign and goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.
In severe forms of the disease (disseminated coccidioidomycosis), antifungal treatment with amphotericin B, fluconazole, or itraconazole can be used. The best length of treatment with these medications has not been determined for this disease.
Written and revised by
Gerald Hurowitz, M.D.
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