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
- Arthroconidia inhaled after contact with contaminated
- Transformed into spherules, which reproduce and produce endospores.
- Endospores released, stimulating acute inflammatory response.
- Tissue infiltrated by mononuclear cells, resulting in
- 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 |Favorite Table|Download (.pdf)
Table 1. Risk Factors
for Severe, Disseminated Infection with Coccidioidomycosis
Race (Filipinos > African-Americans > Native Americans
> Hispanics > Asians)
Pregnancy (especially when infection is acquired or reactivated
in the second or third trimester)
Compromised cellular immune system, including
Patients with B or AB blood types
- 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
- Nonspecific symptoms often indistinguishable from those
of ordinary upper respiratory infections:
- Sore throat
- 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
- “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.
nervous system (CNS) infection occurs in ~16% of patients
with disseminated infection.
- Symptoms subtle and nonspecific
Means of Confirmation
- Direct microscopic examination and histopathologic studies
of infected tissues or secretions provides accurate and rapid method
- Positive skin test develops in most patients within 3 weeks
of symptom onset.
- Culture secretions
- Serologic testing
- Immunoglobulin M to C. immitis peaks within 2–3
weeks of infection, then declines rapidly.
- Immunoglobulin G peaks ...