Cytodiagnostic pitfalls in pulmonary coccidioidomycosis

Cytologic diagnosis of coccidioidomycosis: Spectrum of findings in Southern Arizona patients over a 10 year period

BACKGROUND

The largest series examining the cytological diagnosis of coccidioidomycosis was reported more than 20 years ago and only considered fine needle aspiration (FNA) specimens from pulmonary nodules. Since then, there has been a substantial increase in the incidence of the disease in endemic regions. The aims of this study were to examine the spectrum of Coccidioides in all cytologic specimens and detail their diagnostic and clinical features. The prevalence of infection is also examined against temperature and precipitation data.

METHODS

The Department of Pathology database was retrospectively searched for cases diagnosed as coccidioidomycosis. Climate report was obtained from National Weather Service Forecast Office. Statistical analysis was carried out using JMP version 11.2.0.

RESULTS

The presence of Coccidiodes was microscopically diverse with immature spherules, variably sized spherules, endosporulating spherules, empty spherules, and ruptured spherules being observed. Bronchoalveolar lavages demonstrated the greatest number of different forms of Coccidioides and were associated with acute inflammatory response. Granulomas were rare and mostly seen in lymph nodes and extra pulmonary sites. A necrotic background with paucity of inflammation was frequently seen in lung FNA. Immune competent patients outnumbered immunocompromised patients, illustrating the importance of considering the diagnosis in all patients. The reported association between rainfall and peak prevalence was not observed in our study.

CONCLUSION

Coccidioides has diverse cytological appearance and varied host response depending on the site and type of preparation examined. In endemic areas, the disease should be considered in all patients, independent of immune status, and throughout the year.

Coccidioides immitis: two cases of misidentified mycosis

In the present report, two cases of pulmonary coccidioidomycosis that caused a diagnostic confusion are presented. The first case was initially misdiagnosed as nonsmall cell carcinoma, and both cases were initially misidentified as blastomycosis because of the presence of an atypical morphological form of Coccidioides immitis.

Coccidioidomycosis Pulmonary Infection

Disease caused by Coccidioides immitis has increased in frequency in recent years because of marked population shifts into highly endemic areas, as well as perturbations of the environment caused by construction, agricultural, and natural activities. Because disease may occur in persons in locations outside of the endemic regions, practitioners must be aware of the possibility of infection in those who may have traveled or resided in areas of risk. Recently, advances in laboratory methods have facilitated diagnosis of coccidioidomycosis, and information about therapies that are easier to administer has become available. Challenges in the management of this infection still remain, particularly with regard to more reliable antifungal drugs and protective vaccines.