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PubMedDate not supplied

Coccidioidomycosis in Tulare County, California, 1991: reemergence of an endemic disease.

In 1991, 1208 cases of coccidioidomycosis were reported to the California Department of Health Services, compared with an annual average of 450 during 1986-90. We conducted a study in Tulare County to define the epidemiology of the disease and identify risk factors for severe disease, focusing on the epidemic period September 1991-December 1991. To identify cases, we used data from the Coccidioidomycosis Serology Laboratory at the University of California, Davis, other laboratories, and the Tulare County Health Department's coccidioidomycosis reporting system. We compared patients who were hospitalized with those who were not to determine risk factors for severe disease. We identified 128 cases of acute coccidioidomycosis diagnosed between 1 September and 31 December 1991 (attack rate 41/100,000); south central Tulare County had the highest attack rate. Thirty-five (27%) case-patients were hospitalized. Male sex (relative risk (RR) 2.5, 95% confidence interval (CI) 1.2-5.0), black people and Asian races (RR 4.8, 95% CI 2.4-9.6), and age > or = 20 years (RR 8.3, 95% CI 1.2-57.4) were univariately significant and remained independently associated with hospitalization in multivariate analysis. The 1991 Tulare County outbreak of coccidioidomycosis was part of a much larger outbreak that began in California during 1991 and continued through 1993. The outbreak was preceded by an unusually rainy spring. Although dust reduction measures during times of increased coccidioidomycosis incidence can help reduce exposure, definitive control awaits the development of a safe, effective vaccine.

Adult↗

PubMed2000

Risk factors for acute symptomatic coccidioidomycosis among elderly persons in Arizona, 1996-1997.

Because of the increase in incidence of coccidioidomycosis among the elderly in Arizona between 1990 and 1996, a case-control study was conducted to look at risk factors for disease among these persons. Cases (n=89) were persons aged > or =60 years with laboratory-confirmed coccidioidomycosis; 2 control groups were selected, the first by use of random-digit dialing (geographic controls, n=91) and the second by use of lists of persons with negative serologic coccidioidomycosis tests (laboratory-negative controls, n=58). Elderly persons with coccidioidomycosis had spent significantly less time in Arizona than did persons in either control group and were more likely than geographic controls to have congestive heart failure or cancer, to have smoked, or to have taken corticosteroids. Elderly persons who recently have moved to Arizona or who have chronic illnesses and their physicians need to be aware of their higher risk for coccidioidomycosis in order to improve their chances of early diagnosis and treatment. These persons may benefit from vaccination, once an effective vaccine for coccidioidomycosis is developed.

AIDS-Related Opportunistic Infections↗

PubMed2004

Coccidioidomycosis mimicking ovarian cancer.

BACKGROUND: Dissemination of coccidioidomycosis to the abdominal cavity is rare. No previous case of peritoneal coccidioidomycosis has presented as an adnexal mass. CASE: We report a case of peritoneal coccidioidomycosis mimicking ovarian carcinoma. The patient presented with a complex ovarian mass, ascites, omental caking, and an elevated CA 125. The ultimate diagnosis was not made until frozen section histopathology was performed at staging laparotomy. CONCLUSION: Peritoneal coccidioidomycosis can present with the clinical, radiographic, and serologic features of ovarian cancer. Although essential for diagnosis and staging, radiographic studies and tumor markers have limited specificity. Coccidioidomycosis now joins other benign conditions that comprise the differential diagnosis of patients who present with what seems to be advanced ovarian carcinoma. Infectious diseases consultation is recommended for the management of peritoneal coccidioidomycosis.

Adult↗

PubMed2004

Combating opportunistic infections: coccidioidomycosis.

Coccidioidomycosis is a growing problem in the southwestern US. Although most cases of symptomatic coccidioidomycosis occur in healthy individuals, individuals with depressed cellular immunity are at particular risk. These include individuals with HIV infection, those who have undergone allogeneic transplantation and others on immunosuppressive medications. Most instances of primary pulmonary coccidioidomycosis do not require antifungal therapy. However, almost all cases of disseminated coccidioidomycosis will require such therapy. The triazole antifungals, fluconazole and itraconazole, are effective therapies for coccidioidomycosis. Amphotericin B is now reserved for severe or recalcitrant cases. Coccidioidal meningitis requires lifelong therapy with triazole antifungals. Intrathecal amphotericin B is required for those cases that fail. Prevention of coccidioidomycosis by environmental control is difficult. In the future, immunisation or immune modulation may offer protection.

Antifungal Agents↗

PubMed2002

Reversal of coccidioidal anergy in vitro by dendritic cells from patients with disseminated coccidioidomycosis.

Coccidioides immitis is a pathogenic, dimorphic fungus found in the southwestern United States and is the causative agent of coccidioidomycosis. Extrathoracic dissemination of coccidioidomycosis is associated with a lack of cellular immunity. Dendritic cells (DCs) have been shown to initiate and modulate cellular immune responses. To determine whether DCs could modulate or initiate the immune response in this disease, monocyte-derived DCs were generated from coccidioidal Ag nonresponsive patients with disseminated coccidioidomycosis and healthy nonimmune individuals. DCs generated from both groups demonstrated phenotypes characteristic of DCs and stimulated strong allogeneic MLR. DCs from patients and healthy nonimmune individuals pulsed with the coccidioidal Ag preparation T27K induced lymphocyte proliferation. Mature DCs were much more efficient than immature DCs in these stimulations. Furthermore, restimulation of T27K-primed PBMC with Ag-pulsed DCs generated a C. immitis-specific cellular immune response in PBMC from patients with disseminated coccidioidomycosis as well as healthy nonimmune individuals. These results show that 1) DCs have the capacity to stimulate specific cellular immune responses from patients with disseminated coccidioidomycosis who are nonresponsive to coccidioidal Ag and healthy nonimmune individuals in vitro; 2) DCs can be used to screen coccidioidal Ags as candidates for human vaccine development; and 3) DC therapy may be useful in the treatment of disseminated coccidioidomycosis.

Antigens, Fungal↗

PubMed1986

Coccidioidomycosis of the female genital tract.

Female genital tract involvement is a rare manifestation of disseminated coccidioidomycosis; to our knowledge, only ten patients have previously been described in the English literature. We describe a patient who seems to be unique in that she developed female genital tract coccidioidomycosis and coccidioidal peritonitis after chemotherapy for Hodgkin's disease. Coccidioidomycosis of the female genital tract is usually manifest as granulomatous endometritis and/or granulomatous tubo-ovarian disease with peritonitis. The diagnosis of coccidioidomycosis was unsuspected clinically in all 11 reported cases (including our patient); initial diagnosis was made by biopsy or culture in all 11 patients. In eight of the reported cases of female genital tract coccidioidomycosis (including our patient), clinical improvement occurred after treatment with surgery or antifungal chemotherapy; three patients died of disseminated coccidioidomycosis.

Adult↗

PubMed1993

Unrecognized coccidioidomycosis complicating Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus and treated with corticosteroids. A report of two cases.

Coccidioidomycosis is becoming increasingly recognized as an opportunistic infection among patients infected with the human immunodeficiency virus. We treated two cases of concomitant coccidioidomycosis and Pneumocystis carinii pneumonia. In each case, the diagnosis of coccidioidomycosis was delayed despite appropriate examination of bronchoalveolar lavage fluid. Both patients were treated with antimicrobial therapy directed against P carinii and given adjuvant corticosteroid therapy. In both cases, this led to clinical worsening and was associated with the development of a reticulonodular pulmonary infiltrate on chest roentgenograms. When coccidioidomycosis and Pneumocystis pneumonia occur concomitantly in patients with human immunodeficiency virus infection, the diagnosis of coccidioidomycosis may be delayed or missed. In such cases, corticosteroids may lead to overwhelming coccidioidomycosis. Development of a reticulonodular pulmonary pattern on chest roentgenograms is suggestive of this complication.

AIDS-Related Opportunistic Infections↗

PubMed2026

Oil and gas well development and coccidioidomycosis risk in Kern County, CA, USA: a case-crossover study.

BACKGROUND: Coccidioidomycosis is an emerging fungal disease caused by inhaling Coccidioides spp spores. As spores reside in soil, activities that disturb soil and generate dust can aerosolise and transport the pathogen. The oil and gas industry has been extensively developed in some regions that are endemic for Coccidioides spp and has been associated with dust emissions. Although several adverse health outcomes have previously been associated with oil and gas development, its impact on coccidioidomycosis risk has not been investigated. We aimed to estimate the association between exposure to oil and gas well development (ie, wells in preproduction) and risk of coccidioidomycosis among residents living near new wells. METHODS: In this case-crossover study, we obtained information on reported coccidioidomycosis cases and oil and gas well development between 2007 and 2022 in Kern County, CA, USA. We then compared exposure to preproduction wells within 5 km of each individual's place of residence during both hazard (ie, the 49-139 days before case onset) and control periods using conditional logistic regression. FINDINGS: During the study period, 658 108 (72·4%) of 909 282 of Kern County residents lived within 5 km of at least one preproduction well, and 116 020 (12·8%) lived within 5 km of 23 or more preproduction wells within a single 90-day period. We estimated that the odds of coccidiomycosis incidence were 12·5% (95% CI 5·8-19·6) higher in the 90 days following exposure to at least one preproduction well within 5 km of an individual's place of residence and that the odds of infection increased by 0·7% (0·4-0·9) for each additional preproduction well developed within this distance. INTERPRETATION: These findings support a previously-unrecognised association between the development of oil and gas wells and transmission of coccidioidomycosis, potentially driven by dust generation. Given the prevalence of oil and gas development in the study region, its impact on coccidioidomycosis incidence might be large. FUNDING: National Institutes of Health, National Science Foundation.

Journal Article↗

PubMed1991

Review of human and animal cases of coccidioidomycosis diagnosed in Canada.

The first Canadian case of coccidioidomycosis in a human was reported in 1952 and 11 more cases since then. This study provides details of other cases of coccidioidomycosis that have been diagnosed in Canada. Based on clinical details, isolation of Coccidioides immitis, detection of a specific antibody (F band) for coccidioidomycosis by macro- or microimmunodiffusion tests, concurrently used with the complement fixation procedure, and histopathological findings, 116 more cases of this disease were verified. The great majority (94%) of these cases were diagnosed in the western Canadian provinces of British Columbia, Alberta, Saskatchewan and Manitoba, and the others in Quebec, Ontario and Nova Scotia (5, 1, and 1 cases, respectively). Available information indicates that the C. immitis infections were contracted during visits to endemic areas in the United States (Arizona, California and New Mexico), Mexico, and Bolivia. Pulmonary infections were the most common type of coccidioidomycosis (93%) followed by the disseminated or meningeal types C. immitis infections occurred in individuals with or without predisposing factor(s) and were more common in males than in females. The exoantigen procedure was very useful and reliable in the accurate and rapid identification of suspected C. immitis isolates. Two cases of coccidioidomycosis were reported in animals in Ontario, Canada.

Aged↗

PubMed2004

[Coccidioidomycosis. Two case reports with discussion of current diagnostic and therapeutic issues].

Coccidioidomycosis is a systemic mycosis that is acquired by inhalation. It is endemic in desert-like areas of the southwest USA and neighboring regions, but is becoming increasingly prevalent in other regions of the world as a result of widespread travel. The clinical spectrum is broad, ranging from inapparent infections or symptoms of acute respiratory infection with spontaneous recovery to various manifestations of disseminated coccidioidomycosis. Since the majority of patients with disseminated coccidioidomycosis present with cutaneous manifestations, early diagnosis of this potentially life-threatening disease by dermatologists is important. Atypical skin changes, pulmonary infiltrates and a history of travel to areas where the disease is endemic are indicative of coccidioidomycosis. For conclusive diagnosis, identification of the fungus by histopathologic examination or culture is desirable. Serological tests can be helpful for establishing the diagnosis and monitoring the course of the disease. The treatment of choice for cutaneous coccidioidomycosis is currently oral azole antifungal agents, such as itraconazole 400 mg daily, continued for 6 months after clinical response. Since relapses are frequent after discontinuation of the treatment, close clinical, serological and radiological follow-up is required for years.

Administration, Oral↗

PubMed2001

Coccidioidomycosis in adolescents with lupus nephritis.

Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can cause life-threatening infections in immunosuppressed patients. We report the contrasting cases of two adolescents with lupus nephritis, treated with intravenous pulse cyclophosphamide and daily oral corticosteroids, who developed pulmonary coccidioidomycosis. One patient developed a fatal form of fulminant disseminated coccidioidomycosis, while the other patient developed a solitary pulmonary Coccidioides immitis abscess which was responsive to intravenous liposomal amphotericin and fluconazole therapy. Because serologies and initial X-ray studies can be negative, definitive diagnostic studies including bronchoaveolar lavage and needle aspiration should be performed when there is clinical suspicion of coccidioidomycosis in an immunocompromised patient. Immunosuppressed patients with coccidioidomycosis should receive early intravenous amphotericin therapy and may benefit from long-term suppressive antifungal therapy to prevent relapse.

Abscess↗

PubMed2002

Disseminated coccidioidomycosis with intra- and paravertebral abscesses.

We report a case of paravertebral and intravertebral abscesses caused by Coccidioides immitis in a Japanese man. The patient had lived in Arizona, United States, for 5 years, and suffered from overt disease after coming back to Japan. Culture of pus from the paravertebral abscess revealed Coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made. Fluconazole (600 mg/day), taken orally, was started, and the abscesses surrounding the vertebral bodies disappeared after 2 years of treatment. The abscess in the vertebral bodies also responded to treatment, but a small lesion was still left in the 10th vertebral body after 2 years of treatment. Coccidioidomycosis is a fungal infection that is endemic in the southwestern United States and in Central and South America. Although coccidioidomycosis causes self-limiting flu-like illness or pneumonia, a small proportion of the infections progress to disseminated diseases. Because the incidence of coccidioidomycosis is increasing year by year, physicians not only in endemic but also in nonendemic areas have to consider coccidioidomycosis as one of the differential diagnoses when they examine patients from endemic areas.

Abscess↗

PubMed2006

Coccidioidomycosis in patients with diabetes mellitus.

PURPOSE: The study reviewed the interrelationships of diabetes mellitus and coccidioidomycosis. SUBJECTS AND METHODS: We conducted a retrospective review of the medical records of immunocompetent patients with coccidioidomycosis who were treated at our academic medical institution between January 1, 1999, and October 31, 2003, to compare those with and without diabetes mellitus and to determine whether glycemia correlates with the course of illness. RESULTS: Of 329 immunocompetent patients with coccidioidomycosis, 44 had diabetes (4 type 1 and 40 type 2) and were divided into 2 groups: those with serum glucose concentrations of less than 12.2 mmol/L (220 mg/dL) and those with glucose concentrations of greater than or equal to 12.2 mmol/L (220 mg/dL). Persons with diabetes in either glucose group were more likely than those without diabetes to have cavitary lung disease (relative risk, 2.94; P<.001) and relapsed infection. However, only the diabetes group with serum glucose concentrations greater than or equal to 12.2 mmol/L (220 mg/dL) were more likely to have disseminated infection (relative risk, 2.8; P=.05) and to require treatment (relative risk, 9.85; P=.005), but their infection was less likely to resolve (relative risk, 0.24; P=.002). CONCLUSION: Because glycemia strongly correlated with clinical characteristics of coccidioidomycosis in this cohort, we recommend routine measurement of serum glucose in persons with coccidioidomycosis to identify patients with an increased risk of complicated infection. Future studies should evaluate the efficacy of tight glycemic control on the outcome of coccidioidal infection.

Adult↗

PubMed2006

Iritis presumed as secondary to disseminated coccidioidomycosis.

BACKGROUND: Coccidioidomycosis is a systemic disease caused by a fungus found in soil and transmitted through inhalation. It is prevalent in western and southwestern United States, Mexico, and South and Central America. Results of skin testing, serologic testing, and tissue cultures confirm the diagnosis. Coccidioidomycosis can manifest in various ways: the infected individual may present asymptomatically, with an acute respiratory infection, or, in more severe or chronic cases, with a multiorgan presentation. Ocular involvement may include anterior segment, posterior segment, or extraorbital involvement. CASE REPORT: A case concerning a patient with iritis presumed as secondary to disseminated coccidioidomycosis is discussed. The patient initially presented to our clinic with signs and symptoms of acute, unilateral iritis and a recent history of iritis in the contralateral eye. The active inflammation was treated topically with Pred Forte and cyclopentolate and resolved without sequelae. Because the presentation was bilateral with an asymmetric timecourse, laboratory tests were ordered to rule out systemic association. Because all tests yielded negative results, the known history of disseminated coccidioidomycosis was presumed to be the etiology of this iritis. CONCLUSION: Although eye findings are rare, disseminated coccidioidomycosis is an important differential to consider when a patient presents with uveitis. For this reason, awareness and recognition of ocular signs and symptoms of this disease is significant in proper patient care and management.

Coccidioidomycosis↗

PubMed2005

Abdominal/pelvic Coccidioidomycosis.

BACKGROUND: Coccidioidomycosis is the second most common endemic fungal infection in the southwestern United States. Rarely, this fungal infection exhibits symptoms suggestive of peritoneal malignancy, such as ascites and abdominal pelvic masses. CASE: We present a case involving a 51-year-old woman who presented with abdominal pain, ascites, and elevated serum CA-125 levels in 1995. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed Coccidioidomycosis. Following prolonged treatment with fluconazole, her fungal symptoms resolved completely. CONCLUSION: Patients with Coccidioidomycosis have a good prognosis if they are optimally diagnosed and treated. Ascites and elevated serum CA-125 levels associated with Coccidioidomycosis are not documented in the literature. Although extremely rare, abdominal Coccidioidomycosis could be considered in the differential diagnosis in patients who present with ascites or elevated serum CA-125 levels.

Antifungal Agents↗

PubMed1975

Genitourinary aspects of disseminated coccidioidomycosis.

Genitourinary involvement is common in disseminated coccidioidomycosis. Urologic evaluation should include careful examination, cultures and radiograms. The radiographic features of renal coccidioidomycosis parallel those of renal tuberculosis, with feathery, moth-eaten calices, infundibular constriction and caliceal ballooning, and eventual calcification of granulomas. Coccidioidal epididymitis may be chronic, with long asymptomatic intervals. A patient with a 15-year interval between episodes of right and left coccidioidal epipidymitis is described. Complement fixation titers should be used to determine the activity of genitourinary coccidioidomycosis. In 3 of 12 patients dissemination of coccidioidomycosis occurred during treatment with immunosuppressive medications. Renal transplant patients should be evaluated for active coccidioidomycosis prior to transplantation.

Abscess↗

PubMed1994

Coccidioidomycosis iridocyclitis.

BACKGROUND: Coccidioidomycosis has reached epidemic proportions in the southwest region of the United States. Despite the greater numbers of cases, isolated anterior segment ocular coccidioidomycosis in the absence of systemic infection continues to be rare, although its incidence may be increasing. METHODS: Two patients without clinical evidence of systemic disease and one patient with previously treated pulmonary coccidioidomycosis had granulomatous iridocyclitis and iris nodules that were unresponsive to corticosteroid therapy. All three patients underwent iris biopsy, anterior chamber tap, and washout for histopathologic diagnosis of anterior segment disease, and all subsequently received systemic antifungal therapy. Two patients also received multiple intraocular injections of amphotericin B. RESULTS: Papanicolaou and hematoxylin-eosin-stained preparations of anterior chamber tap and biopsies of the iris in each of these patients showed fibrinopurulent or granulomatous inflammatory exudate with intact and disrupted Coccidioides spherules. Despite aggressive systemic and intraocular therapy, one patient required enucleation for a blind, painful eye. The other two patients continue to have limited visual acuity but with at least partial resolution of the intraocular lesions. CONCLUSIONS: Ocular coccidioidomycosis without clinical evidence of systemic involvement is rare. Isolated anterior segment disease is also uncommon; however, because of the current epidemic in the southwest region of the United States, ocular coccidioidomycosis should be considered in any patient who traveled through or lived in endemic areas and who has a granulomatous iridocyclitis associated with iris mass that is unresponsive to corticosteroid therapy.

Amphotericin B↗

PubMed2000

Surgical management of coccidioidomycosis in children.

BACKGROUND/PURPOSE: Operations for Coccidioides immitis infection in children have received little study. The authors perceived an increase in the number of patients requiring operations for coccidioidomycosis at Phoenix Children's Hospital. The authors therefore reviewed the surgical management of children with C immitis infection in Phoenix, Arizona. METHODS: The medical records of all children hospitalized from 1994 to 1999 with a confirmed laboratory diagnosis of coccidioidomycosis were reviewed. Age, gender, race, immune status, laboratory data, operations, and outcome were recorded. RESULTS: Of 39 children with proven coccidioidomycosis, 21 patients (54%) underwent a total of 49 operations. Boys represented 72% of all children reviewed. Sixteen patients (29% of the operative cohort) were immunocompromised. Thoracic procedures (19 cases) were most frequent. CONCLUSIONS: Over half the children hospitalized for coccidioidomycosis required at least 1 operation. Most were immunocompetent boys with thoracic disease. Pediatric surgeons, who provide the bulk of operative care, should expect to encounter coccidioidomycosis in endemic areas, and increasingly in nonendemic areas.

Adolescent↗