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Source: Carver PL. Invasive Fungal Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8005562.

  • Systemic fungal infection

  • Systemic fungal infection caused by Coccidioides immitis

  • Arthroconidia inhaled after contact with contaminated soil.
  • Transformed into spherules, which reproduce and produce endospores.
  • Endospores released, stimulating acute inflammatory response.
    • Tissue infiltrated by mononuclear cells, resulting in granuloma formation.

  • Coccidioides immitis grows in soil as mold
  • Endemic regions encompass semiarid areas of southwestern United States from California to Texas

  • No risk factors for primary disease, but factors that affect risk of subsequent dissemination of disease are summarized in Table 1.

Table 1. Risk Factors for Severe, Disseminated Infection with Coccidioidomycosis

  • Spectrum of illnesses ranging from primary uncomplicated respiratory tract infection that resolves spontaneously to progressive pulmonary or disseminated infection.
  • 60% of patients asymptomatic; 10- to 30-day incubation period.

Signs and Symptoms

  • Nonspecific symptoms often indistinguishable from those of ordinary upper respiratory infections:
    • Fever
    • Cough
    • Headache
    • Sore throat
    • Myalgias
    • Fatigue
    • Fine, diffuse rash may appear during first few days of illness
  • Chronic, persistent pneumonia or persistent pulmonary coccidioidomycosis (primary disease lasting >6 wk)
    • Complicated by hemoptysis, pulmonary scarring, and formation of cavities or bronchopleural fistulas.
  • “Valley fever” (25% of patients)
    • Syndrome characterized by erythema nodosum and erythema multiforme of upper trunk and extremities in association with diffuse joint aches or fever.
  • Disseminated infection (<1% of patients)
    • Dissemination may occur to skin, lymph nodes, bone, meninges, spleen, liver, kidney, and adrenal gland.
      • Central nervous system (CNS) infection occurs in ~16% of patients with disseminated infection.
      • Symptoms subtle and nonspecific

Means of Confirmation and Diagnosis

  • Direct microscopic examination and histopathologic studies of infected tissues or secretions provides accurate and rapid method of diagnosis.
  • Positive skin test develops in most patients within 3 weeks of symptom onset.

Laboratory Tests

  • Culture secretions
  • Serologic testing
    • Immunoglobulin M to C. immitis peaks within 2–3 weeks of infection, then declines rapidly.
    • Immunoglobulin G peaks in 4–12 weeks and declines ...

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