Systemic coccidioidomycosis

Alternative names

Coccidioidomycosis - disseminated

Definition

Coccidioidomycosis is a a disease caused by breathing in a fungus (Coccidioides immitis) found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America. It spreads through the bloodstream to involve many organs.

Causes, incidence, and risk factors

Coccidioidomycosis is caused by breathing in the spores of a fungus in desert regions. About 60% of acute infections cause no symptoms and are only recognized by a positive coccidioidin skin test. In the remaining 40%, symptoms range from mild to severe.

In disseminated disease, extension of infection to the bones, lungs, liver, meninges, brain, skin, heart, and pericardium (sac around the heart) may take place.

Meningitis occurs in 30-50% of cases of disseminated disease. Immunodeficient (immunosuppressed) people, including those with HIV infection, diabetics, and pregnant women of any race are more prone to the disease. Recent travel to or residence in southwestern deserts of the U.S. is a risk factor.

Symptoms

• cough
  
• fever
  
• chills
  
• headache
  
• muscle stiffness
  
• muscle aches
  
• neck stiffness or shoulder stiffness
  
• change in mental status
  
• sensitivity to light
  

Additional symptoms that may be associated with this disease:

• joint swelling
  
• joint pain
  
• skin reaction (erythema nodosum)
  
• arthritis
  
• ankle, feet, and leg swelling
  

Signs and tests

• sputum smear (KOH test)
  
• sputum culture
  
• serum coccidioides complement fixation titer
  
• coccidioidin skin test
  
• CBC with differential
  
• chest X-ray
  
• biopsy of tissue in area of disseminated disease
  o bone marrow biopsy
  o liver biopsy
  o open lung biopsy
  o skin lesion biopsy