Coccidioidomycosis is a fungal infection also known as California Valley Fever. Symptoms of coccidioidomycosis may not be noticeable to you, but some infections can lead to very serious he alth problems. What is coccidioidomycosis, how is it diagnosed and what is the treatment like?

Coccydioidomycosis(California Valley Fever, Cocci, Valley Fever, Desert Rheumatism, San Joaquinto Valley Fever) is a fungal infection caused byCoccidioides immitisorC. posadasii . The fungus causes a primary infection - single or multifocal. Secondly, there may be a generalized invasion involving all organs.

The disease is endemic to the Americas. There are cases of mycosis being spread to other regions of the world. Occupational groups of mine workers, archaeological excavations and people with reduced immunity are particularly vulnerable to infection

Coccydioidomycosis: mode of infection

The spores of the fungus are in the soil. The rainy season and the long hot summer favor the development of mycelium.

The fungus is transmitted through the air thanks to light arthrospores, and it enters the human body through the respiratory system.

90% of the population is infected in endemic zones.

Fungal cells multiply in the tissues and spread through the bloodstream. The pathogen relatively often infects the tissues of the central nervous system.

Coccydioidomycosis: Symptoms

Coccidioidomycosis is asymptomatic in half of the cases or occurs as a short-term respiratory infection. The risk of developing symptoms increases with age. Flu-like symptoms may occur 7-28 days after exposure:

  • fever
  • muscle aches
  • cough
  • night sweats
  • chest pains
  • limiting exercise tolerance

which usually go away without treatment.

Coccidioidomycosis is usually misdiagnosed as community acquired bacterial pneumonia.

At the same time, in the first few days of the disease, a macular or maculopapular rash appears on the skin (in 50% of patients), erythema nodosum (typically on the lower limbs) or erythema multiforme (usually aroundneck) these symptoms are especially common in women.

Pains and arthritis may also appear.

In chronic pulmonary form, symptoms such as increased body temperature, hemoptysis are added.

In immunocompromised people, symptoms may persist for months leading to exhaustion.

The disease can even lead to death.

Nodular lesions and thin-walled pits appear in the lungs, most often at the apexes. Breakthrough into the pleural cavity and the formation of an empyema with pneumothorax (pyopneumothorax) are rare. In such cases, patients experience acute dyspnea, and chest X-rays show a collapsed lung and pleural fluid levels

There may also appear abscesses and bronchopulmonary fistulas. The picture resembles tuberculosis, it leads to a decrease in respiratory efficiency. Chest X-ray is then an important diagnostic test.

The disease may take an extrapulmonary form, locating in the bones, central nervous system and skin.

Infection may also appear in a diffuse form (5% of cases) - spreading the disease to bones, joints, skin and subcutaneous tissue, as well as the central nervous system.

25% of patients with disseminated disease develop meningitis, which, if left untreated, is always fatal.

Patients usually present with a persistent headache, occasionally associated with somnolence and confusion. The stiffness of the neck, if at all, is not significant.

Lymphocytic pleocytosis with a significant decrease in glucose and elevated protein levels is observed in the study of cerebrospinal fluid. Occasionally, eosinophilia may be observed in the cerebrospinal fluid.

Regardless of the treatment used, patients may develop hydrocephalus as a complication, which manifests itself as a marked decline in mental performance, often associated with a gait disturbance.

Dissemination is more common in men, mainly of African-American or Filipino origin, and in people with impaired cellular immunity, including patients with HIV infection and CD4 + T cell levels
Women who become infected with coccidioidomycosis in the second or third trimester of pregnancy, they are also at risk of spreading the disease.

Coccydioidomycosis: diagnosis

The fungus is detected by microscopic mycological examination of material collected from the patient (skin scrapings, cerebrospinal fluid, bronchial washes) by culture, finding spores.

In the histopathological examination of the retrieved organ, we canidentify typical granulomas, and spore spheres are also detected.

There are also skin tests to detect chronic or systemic C. immitis infection. It should be remembered that in people treated with immunosuppressants, skin tests will give a false negative. In the acute form of the disease, eosinophilia is detected in the morphology.

Coccydioidomycosis: treatment

The disease is usually asymptomatic and does not require treatment.

Among patients in the endemic zone, most develop a sufficiently high level of immunity. Only about 5% of the population requires treatment in these areas.

Extensive lung lesions usually require surgical intervention, which should be preceded by treatment with Amphotericin for 4 weeks or ketoconazole / itraconazole / fluconazole for 6-12 months.

Triazole drugs are currently the main group of drugs in the treatment of most cases of coccidioidomycosis.

Clinical trials prove that both fluconazole and itraconazole are effective, and evidence suggests that itraconazole may be more effective.

Amphotericin B is currently reserved for the most severe, diffuse cases.

Category:

Infectious diseases