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Wilson DL, Kollampare S, Kwoh CK, Zhou L, Ashbeck EL, Sudano D, Lupi M, Miller A, Smith K, Lo‐Ciganic W. Coccidioides Serologic Screening Practices in Individuals With Rheumatic and Autoimmune Diseases. ACR Open Rheumatol 2024; 6:380-387. [PMID: 38477182 PMCID: PMC11168914 DOI: 10.1002/acr2.11663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE We aimed to estimate Coccidioides serologic screening rates before initiation of biologic disease-modifying antirheumatic drugs including tofacitinib (b/tsDMARDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and/or noninhaled corticosteroids. METHODS This retrospective cohort study used 2011 to 2016 US Medicare claims data and included beneficiaries with rheumatic or autoimmune disease residing in regions within Arizona, California, and Texas endemic for Coccidioides spp. with ≥1 prescription for a b/tsDMARD, csDMARD, and/or noninhaled corticosteroid. We estimated prior-year serologic screening incidence before initiating b/tsDMARDs, csDMARD, and/or noninhaled corticosteroid. RESULTS During 2012 to 2016, 4,331 beneficiaries filled 64,049 prescriptions for b/tsDMARDs, csDMARDs, and noninhaled corticosteroids. Arizona's estimated screening rate was 20.1% (95% confidence interval [95% CI] 14.5-25.7) in the year before prescription initiation for b/tsDMARDs, 8.1% (95% CI 6.5-9.7) before csDMARDs, and 6.9% (95% CI: 5.6-8.2) before corticosteroids. Screening rates for b/tsDMARDs (2.8%, 95% CI 0.0-6.7), csDMARDs (1.0%, 95% CI 0.0-2.0), and corticosteroids (0.8%, 95% CI: 0.4-1.1) were negligible in California and undetected in Texas. Adjusted screening rate before prescription for b/tsDMARDs in Arizona increased from 14.5% (95% CI 7.5-21.5) in 2012 to 26.7% (95% CI 17.6-35.8) in 2016. Rheumatologists prescribing b/tsDMARDs in Arizona screened more than other providers (20.9% [95% CI 13.9-27.9] vs 12.9% [95% CI 5.9-20.0]). CONCLUSION Coccidioides serologic screening rates among Medicare beneficiaries with rheumatic/autoimmune diseases on b/tsDMARDs, csDMARDs, and noninhaled corticosteroids was low in Coccidioides spp.-US endemic regions between 2012 and 2016. Alignment of screening recommendations and clinical practice is needed.
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Affiliation(s)
| | | | - C. Kent Kwoh
- University of Arizona and The University of Arizona Arthritis CenterTucson
| | - Lili Zhou
- The University of Arizona Arthritis CenterTucson
| | | | - Dominick Sudano
- University of Arizona and The University of Arizona Arthritis CenterTucson
| | | | | | | | - Wei‐Hsuan Lo‐Ciganic
- University of Pittsburgh, Pittsburgh, Pennsylvania, and Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health SystemGainesvilleFlorida
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2
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Wilson DL, Zhou L, Sudano DG, Ashbeck EL, Kwoh CK, Krebs L, Sheer A, Smith J, Tudeen M, Lo‐Ciganic W. Risk of Coccidioidomycosis Infection Among Individuals Using Biologic Response Modifiers, Corticosteroids, and Oral Small Molecules. ACR Open Rheumatol 2024; 6:287-293. [PMID: 38425143 PMCID: PMC11089439 DOI: 10.1002/acr2.11654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE The study objective was to examine associations between the use of biologic response modifiers (BRMs), corticosteroids, and oral small molecules (OSMs) and subsequent coccidioidomycosis infection risk among US Medicare beneficiaries with rheumatic or autoimmune diseases. METHODS This retrospective cohort study used US 2011 to 2016 Medicare claims data. We identified geographic areas with endemic coccidioidomycosis (≥25 cases per 10,000 beneficiaries). Among beneficiaries having any rheumatic/autoimmune diseases, we identified those initiating BRMs, corticosteroids, and OSMs. Based on refill days supplied, we created time-varying exposure variables for BRMs, corticosteroids, and OSMs with a 90-day lag period after drug cessation. We examined BRMs, corticosteroids, and OSMs and subsequent coccidioidomycosis infection risk using multivariable Cox proportional hazard regression. RESULTS Among 135,237 beneficiaries (mean age: 67.8 years; White race: 83.1%; Black race: 3.6%), 5,065 had rheumatic or autoimmune diseases, of which 107 individuals were diagnosed with coccidioidomycosis during the study period (6.1 per 1,000 person-years). Increased risk of coccidioidomycosis was observed among beneficiaries prescribed any BRMs (17.7 per 1,000 person-years; adjusted hazard ratio [aHR] 3.94; 95% confidence interval [CI] 1.18-13.16), followed by individuals treated with only corticosteroids (12.2 per 1,000 person-years; aHR 2.29; 95% CI 1.05-5.03) compared to those treated with only OSMs (4.2 per 1,000 person-years). The rate of those treated with only OSMs was the same as that of beneficiaries without these medications. CONCLUSION Incidence of coccidioidomycosis was low among 2011 to 2016 Medicare beneficiaries with rheumatic or autoimmune diseases. BRM and corticosteroid users may have higher risks of coccidioidomycosis compared to nonusers, warranting consideration of screening for patients on BRMs and corticosteroids in coccidioidomycosis endemic areas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wei‐Hsuan Lo‐Ciganic
- University of Pittsburgh, Pittsburgh, Pennsylvania and North Florida/South Georgia Veterans Health System, Geriatric Research Education and Clinical CenterGainesvilleFlorida
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Eulálio KD, Kollath DR, Martins LMS, Filho ADD, Cavalcanti MDAS, Moreira LM, Tenório BG, Alves LGDB, Yamauchi D, Barrozo LV, Thompson Iii GR, Nacher M, Stajich JE, Benard G, Bagagli E, Felipe MSS, Barker BM, Trilles L, Teixeira MDM. Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil. Nat Commun 2024; 15:3190. [PMID: 38609393 PMCID: PMC11014852 DOI: 10.1038/s41467-024-47388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978-2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.
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Affiliation(s)
- Kelsen Dantas Eulálio
- Hospital de Doenças Infecto Contagiosas-HDIC, Federal University of Piauí-UFPI, Teresina, Piauí, Brazil
| | - Daniel R Kollath
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Antonio de Deus Filho
- Hospital de Doenças Infecto Contagiosas-HDIC, Federal University of Piauí-UFPI, Teresina, Piauí, Brazil
| | | | - Lucas Machado Moreira
- Evandro Chagas National Institute of Infectology, Fiocruz - RJ, Rio de Janeiro, Brazil
| | | | | | - Danielle Yamauchi
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
| | - Ligia Vizeu Barrozo
- Department of Geography, Faculty of Philosophy, Languages and Literature, and Human Sciences, University of São Paulo, São Paulo, Brazil
| | - George R Thompson Iii
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, UC-Davis, Sacramento, CA, USA
| | - Mathieu Nacher
- Centre d'Investigations Cliniques, INSERM 1424, Centre hospitalier de Cayenne - French Guiana, Cayenne, French Guiana
| | - Jason E Stajich
- Department of Microbiology and Plant Pathology University of California-Riverside, Riverside, CA, USA
| | - Gil Benard
- Laboratório de Micologia Medica, Departamento de Dermatologia, Instituto de Medicina Tropical, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
| | | | - Bridget M Barker
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Luciana Trilles
- Evandro Chagas National Institute of Infectology, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Marcus de Melo Teixeira
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA.
- Faculty of Medicine, University of Brasília, Brasília, Federal District, Brazil.
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Tsantes AG, Koutserimpas C, Naoum S, Drosopoulou LP, Papadogeorgou E, Petrakis V, Alpantaki K, Samonis G, Veizi E, Papadopoulos DV. Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review. J Fungi (Basel) 2024; 10:270. [PMID: 38667941 PMCID: PMC11050809 DOI: 10.3390/jof10040270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Extrapulmonary infections by Coccidioides spp., though rare, can occur via dissemination, affecting singular or multiple sites, including the skin and musculoskeletal system. Skeletal involvement often manifests as osteomyelitis, particularly in the axial skeleton. The present systematic review evaluates all documented cases of skeletal coccidioidomycosis to assess the diagnostic and treatment strategies alongside the outcomes, drawing insights from an analysis of 163 verified cases. A systematic review following PRISMA guidelines identified all studies reporting skeletal infections by Coccidioides spp. up to 2023 from the PubMed and Scopus databases. Eligible studies evaluated osteoarticular infections from Coccidioides spp. Data extraction included demographics, microbiological data, diagnostic methods, and treatment outcomes. Of the 501 initially identified records, a total of 163 patients from 69 studies met the inclusion criteria. Most cases were from the USA, predominantly males, while the median age of the population was 36 years. Diabetes mellitus was the common comorbidity (14.7%). C. immitis was the most prevalent pathogen. The spine and hand were common sites of infection (17.5% and 15.1%, respectively). Osteomyelitis by Coccidioides spp. was diagnosed, in most cases, by positive cultures (n = 68; 41.7%), while, in 49 (30.9%), both the histological examination and cultures yielded the fungus. Surgical debridement was performed in 80.9% of cases. A total of 118 (72.3%) patients were treated with monotherapy, while combination therapy with two or more antifungal agents was reported in 45 (17.7%). Amphotericin B (either liposomal or deoxycholate) was the most commonly given agent as monotherapy in 51 (31.2%) patients, while 30 (18.4%) patients received itraconazole as monotherapy. The rate of infection's resolution was higher in patients undergoing surgical debridement (79.5%), compared to those treated only with antifungal agents (51.6%, p = 0.003). Treatment outcomes showed complete resolution in 74.2% of patients, with a mortality rate of 9.2%. Coccidioidal osseous infections present diagnostic and therapeutic challenges. Surgical intervention is often necessary, complementing antifungal therapy. Vigilance for Coccidioides spp. infections, especially in regions with endemicity, is crucial, particularly when bacterial cultures yield negative results.
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Affiliation(s)
- Andreas G. Tsantes
- Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Christos Koutserimpas
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69317 Lyon, France;
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Symeon Naoum
- Department of Trauma and Orthopedics, Royal Berkshire Hospital, Reading RG1 5AN, UK;
| | | | - Ellada Papadogeorgou
- Department of Orthopedics, Interbalkan Medical Center, 55535 Thessaloniki, Greece;
| | - Vasileios Petrakis
- 2nd University Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68131 Alexandroupolis, Greece;
- Department of Infectious Diseases, HIV Unit, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68131 Alexandroupolis, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Heraklion, 71409 Iraklio, Greece;
| | - George Samonis
- First Department of Medical Oncology, Metropolitan Hospital of Neon Faliron, 18547 Athens, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Yıldırım Beyazıt University, Ankara City Hospital, 2367 Ankara, Turkey
| | - Dimitrios V. Papadopoulos
- 2nd Academic Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, 14233 Athens, Greece;
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Reyes-Montes MDR, León-García AA, Frías-De-León MG, Acosta-Altamirano G, Sánchez-Saavedra EP, Victoriano-Pastelín I, Meraz-Ríos B, Duarte-Escalante E. Clinical Cases of Coccidioidomycosis in the Americas in the Period 1950-2021: Epidemiology Data, Diagnosis, and Treatment. Life (Basel) 2023; 13:2109. [PMID: 38004249 PMCID: PMC10672650 DOI: 10.3390/life13112109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Coccidioidomycosis, caused by Coccidioides immitis and C. posadasii, causes significant morbidity and mortality, both in immunocompetent and immunocompromised people, mainly in endemic areas. The present work analyzed its epidemiology, diagnostic methods, and treatment by reviewing clinical cases published from 1950 to 2021. Fifty-nine articles were included, corresponding to 275 clinical cases. The results showed a higher incidence of coccidioidomycosis in the male gender than the female gender. The most affected age group was 31-40 years, and the most reported clinical presentation was disseminated with greater involvement in cutaneous and subcutaneous tissue, followed by the CNS, bone system, and peritoneum. The species most frequently reported was C. immitis. The most used treatment was azoles, followed by their combination with amphotericin B, monotherapy with amphotericin B, and alternative medicine. This work shows that epidemiological data outside the USA are still scarce. Serological tests are the preferred diagnostic method in daily medical practice, and cultures remain the gold standard. The treatment for coccidioidomycosis is ketoconazole and amphotericin B, individually or in combination.
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Affiliation(s)
- María del Rocío Reyes-Montes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Adriana Anel León-García
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - María Guadalupe Frías-De-León
- Hospital Regional de Alta Especialidad de Ixtapaluca, Unidad de Investigación Biomédica, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (G.A.-A.)
| | - Gustavo Acosta-Altamirano
- Hospital Regional de Alta Especialidad de Ixtapaluca, Unidad de Investigación Biomédica, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (G.A.-A.)
| | - Erika Paola Sánchez-Saavedra
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Isai Victoriano-Pastelín
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Beatriz Meraz-Ríos
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
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6
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Schwartz IS, Marek C, Sandhu H, Abdelmonem A, Petersen G, Dishner E, Heidari A, Thompson GR. Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis. Emerg Infect Dis 2023; 29:1297-1301. [PMID: 37347877 PMCID: PMC10310367 DOI: 10.3201/eid2907.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.
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Campbell AP, Qiu L, Dillman JR, Trout AT, Szabo S, Lopez-Nunez OF, Pugmire BS, Schapiro AH. Endemic mycoses in children in North America: a review of radiologic findings. Pediatr Radiol 2023; 53:984-1004. [PMID: 36922418 PMCID: PMC10017348 DOI: 10.1007/s00247-023-05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.
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Affiliation(s)
- Abraham P Campbell
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Lisa Qiu
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Szabo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oscar F Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian S Pugmire
- Department of Radiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Andrew H Schapiro
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Peçanha-Pietrobom PM, Tirado-Sánchez A, Gonçalves SS, Bonifaz A, Colombo AL. Diagnosis and Treatment of Pulmonary Coccidioidomycosis and Paracoccidioidomycosis. J Fungi (Basel) 2023; 9:218. [PMID: 36836333 PMCID: PMC9959547 DOI: 10.3390/jof9020218] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Coccidioidomycosis (CM) and paracoccidioidomycosis (PCM) are systemic mycoses that are highly endemic in Latin America and have recently been included on the World Health Organization (WHO) Fungal Priority Pathogens List. Coccidioides immitis and Coccidioides posadasii are recognized as etiological agents of CM, with peculiarities in their geographic distribution. The genus Paracoccidioides now includes Paracoccidioides lutzii and the Paracoccidioides brasiliensis complex, which encompasses four phylogenetic species. In both diseases, pulmonary signs and symptoms are the main reasons for patients to seek medical assistance, and they are frequently misdiagnosed as tuberculosis. In this paper, we present a critical view of the strategies for diagnosis and clinical management of CM and PCM. Over the past few decades, there has been an increase in the number of reports of endemic fungal infections in areas previously thought to be "non-endemic" due to climate change and increased travel, among other factors. Learning to recognize their main epidemiological aspects and clinical manifestations is crucial so that clinicians can include them in the differential diagnosis of lung disease and avoid late diagnosis.
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Affiliation(s)
| | - Andrés Tirado-Sánchez
- Dermatology Service & Mycology Department, Hospital General de México, “Dr. Eduardo Liceaga”, Mexico City 06726, Mexico
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Sarah Santos Gonçalves
- Department of Pathology, Infectious Diseases Postgraduate Program, Federal University of Espírito Santo (UFES), Vitoria 29043900, Brazil
| | - Alexandro Bonifaz
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04039032, Brazil
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Muacevic A, Adler JR, Elhassan M. Diagnosing Pulmonary Embolism Using Point-of-Care Ultrasound in a Patient With Malingering and Coccidioidomycosis Infection. Cureus 2023; 15:e34288. [PMID: 36843761 PMCID: PMC9957573 DOI: 10.7759/cureus.34288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/30/2023] Open
Abstract
We report a case of a 41-year-old male diagnosed with pulmonary coccidioidomycosis and pulmonary embolism (PE) based on a point-of-care ultrasound (POCUS) finding who was suspected to be malingering for right-sided chest pain considering his psychiatric history. POCUS was performed and showed right ventricular strain with a D-shaped left ventricle and B-lines with subpleural consolidations, and PE was confirmed with computed tomography pulmonary angiography. No other risk factors for PE were found except for coccidioidomycosis. The patient was treated with apixaban and fluconazole and discharged in stable condition. We discuss the usefulness of POCUS in diagnosing PE and the very rare association between coccidioidomycosis and PE.
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Affiliation(s)
| | - John R Adler
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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10
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Khan A, Moni SS, Ali M, Mohan S, Jan H, Rasool S, Kamal MA, Alshahrani S, Halawi M, Alhazmi HA. Antifungal Activity of Plant Secondary Metabolites on Candida albicans: An Updated Review. Curr Mol Pharmacol 2023; 16:15-42. [PMID: 35249516 DOI: 10.2174/1874467215666220304143332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022]
Abstract
Fungal infections have been increasing continuously worldwide, especially in immunocompromised individuals. Fungi, regarded as eukaryotic pathogens, have many similarities to the host cells, which inhibit anti-fungal drug development progress. Various fungal model systems have been studied, and it was concluded that Candida spp. is the most common disease-causing fungus. Candida species are well known to cause infections not only in our mouth, skin, and vagina, but they are also a frequent cause of life-threatening hospital bloodstream infections. The morphological and developmental pathways of Candida have been studied extensively, providing insight into the fungus development. Candida albicans is known to be the most pathogenic species responsible for a variety of infections in humans. Conventional anti-fungal drugs, mainly azoles drugs available in the market, have been used for years developing resistance in C. albicans. Hence, the production of new anti-fungal drugs, which require detailed molecular knowledge of fungal pathogenesis, needs to be encouraged. Therefore, this review targets the new approach of "Green Medicines" or the phytochemicals and their secondary metabolites as a source of novel anti-fungal agents to overcome the drug resistance of C. albicans, their mechanism of action, and their combined effects with the available anti-fungal drugs.
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Affiliation(s)
- Andleeb Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | | | - M Ali
- Department of Pharmacognosy, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, 45142, Saudi Arabia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Huma Jan
- Department of Clinical Biochemistry, University of Kashmir, Hazratbal, Srinagar -190006, J&K, India
| | - Saiema Rasool
- Department of School Education, Govt. of Jammu & Kashmir, Srinagar, 190001 J&K, India
| | - Mohammad A Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, P. O. Box 80216, Jeddah 21589. Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
- Enzymoics, 7 Peterlee place, Hebersham, NSW 2770; Novel Global Community Educational Foundation, Australia
| | - Saeed Alshahrani
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Maryam Halawi
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Hassan A Alhazmi
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, 45142, Saudi Arabia
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
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11
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Mato V, Herrera S, Cofan F, Bodro M. Pulmonary nodules after kidney transplant. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:48-49. [PMID: 36621248 DOI: 10.1016/j.eimce.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Víctor Mato
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
| | - Frederic Cofan
- Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
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12
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Krase IZ, Garabedian E, Fuleihan R, Sacco K. Prevalence of coccidioidomycosis in primary immunodeficiency: Data from the USIDNET registry. Clin Immunol 2022; 245:109135. [PMID: 36184050 DOI: 10.1016/j.clim.2022.109135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Ifat Z Krase
- Division of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix, AZ, USA; Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Elizabeth Garabedian
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramsay Fuleihan
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, NY, New York, USA
| | - Keith Sacco
- Division of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix, AZ, USA; Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
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13
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Sivasubramanian G, Kadakia S, Kim JM, Pervaiz S, Yan Y, Libke R. Spinal Arachnoiditis in Patients with Coccidioidomycosis Meningitis-Analysis of Clinical and Imaging Features. J Fungi (Basel) 2022; 8:1180. [PMID: 36354947 PMCID: PMC9697661 DOI: 10.3390/jof8111180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 06/28/2024] Open
Abstract
Background: Coccidioidomycosis meningitis (CM) is the most aggressive form of coccidioidomycosis, requiring lifelong antifungal treatment and often cerebrospinal fluid (CSF) diversion. Long-standing CM can be associated with spinal complications such as arachnoiditis. However, studies describing the frequency, clinical, and imaging characteristics of arachnoiditis in patients with CM are limited. Methods: We identified 133 patients with CM based on CSF culture, PCR, or serology between January 2010 and December 2020. Of these, 37 patients underwent spinal imaging. Data on demographics, risk factors, symptoms, antifungal therapy, surgical management, follow-up visits, adherence, serological trends, and imaging findings were reviewed. Results: Abnormal findings were observed in 30 of the 37 patients with CM who underwent spinal imaging. The imaging abnormalities noted in our study included leptomeningeal enhancement (53%), arachnoiditis (53%), syringomyelia (23%), cord signal abnormalities (10%), and osteomyelitis (7%). Of the 30 patients, 90% had symptoms, such as weakness, numbness, or urinary retention. The incidence of arachnoiditis in the present study was 12%. Higher initial CSF protein levels and intra cranial pressure were associated with a higher risk of developing arachnoiditis/syringomyelia. Management of CM was challenging, as evidenced by shunt failure (46%), medication non-compliance (57%), and lack of adequate follow-up (60%). Persistent disabilities were noted in 62% of the patients. Conclusions: Patients with CM develop spinal complications such as arachnoiditis, or syringomyelia. Many cases may go undetected due to lack of symptoms in early stages. CM management challenges such as shunt failure, lack of follow-up care, and medication noncompliance, were frequent.
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Affiliation(s)
| | - Saurin Kadakia
- Department of Internal Medicine, University of California, Fresno, CA 93701, USA
| | - Jani M. Kim
- Department of Infectious Disease, University of California, Fresno, CA 93701, USA
| | - Sarah Pervaiz
- Department of Infectious Disease, University of California, Fresno, CA 93701, USA
| | - Yueqi Yan
- HSRI Biostatistics and Data Support Core, University of California, Merced, CA 95343, USA
| | - Robert Libke
- Department of Infectious Disease, University of California, Fresno, CA 93701, USA
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14
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Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, Pasini R, Mançano A, Souza A, Pasqualotto AC, Hochhegger B. Chest Imaging in Systemic Endemic Mycoses. J Fungi (Basel) 2022; 8:1132. [PMID: 36354899 PMCID: PMC9692403 DOI: 10.3390/jof8111132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 09/20/2023] Open
Abstract
Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Edson Marchiori
- Radiology Department, Universidade Federal de Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Ali Youssef
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Tan-Lucien Mohammed
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Pratik Patel
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Klaus Irion
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Romulo Pasini
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Alexandre Mançano
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Arthur Souza
- Radiology Department, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
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15
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Fatima M, Patel RS, Brunworth JR, Gupta KA, Roach WE, Webeler PL, Mundelein CR, Mansour M. A Case of Rapidly Progressive Coccidioidal Meningitis in an Immunocompetent Patient. Cureus 2022; 14:e28643. [PMID: 36120197 PMCID: PMC9464446 DOI: 10.7759/cureus.28643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
A 50-year-old male with a history of a dull headache and neck pain for a few weeks presented to the ER with complaints of progressive weakness and difficulty walking. Physical examination revealed a lethargic, confused patient with abnormal tremors at rest. Initial lab work was significant for elevated hemoglobin, hematocrit, and hyponatremia. Additionally, CT imaging was significant for prominent ventricles. Several serologies and polymerase chain reaction (PCR) tests were ordered to determine the etiology of the patient’s meningitis. On day 10 of admission, serology results returned positive for Coccidioides antibodies. The patient was started on an IV fluconazole treatment and underwent a ventriculoperitoneal shunt and Ommaya reservoir placement procedure. Cases of coccidioidal meningitis are rarely noted in recent literature. We present this clinical case of coccidioidomycosis dissemination into the central nervous system (CNS) to highlight the rare localization of the fungal infection in a baseline immunocompetent patient.
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16
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Macías-Rioseco M, Sheley M, Ochoa J, Carvallo-Chaigneau FR, Uzal FA. Coccidioidomycosis in 26 horses in California, USA: case series and review of the literature. J Vet Diagn Invest 2022; 34:995-999. [PMID: 35879871 PMCID: PMC9597331 DOI: 10.1177/10406387221114622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coccidioidomycosis is a fungal disease caused by Coccidioides immitis or Coccidioides posadasii. We searched the records of the California Animal Health and Food Safety Laboratory from 1990 through 2020 for cases of coccidioidomycosis in horses. The selection criteria for these cases were: 1) live-born horses submitted for autopsy, and 2) a diagnosis of coccidioidomycosis was established, regardless of cause of death. During that time, 19,054 horses were received, and 26 cases (0.14%) of coccidioidomycosis were diagnosed in horses, of which 19 (73%) cases had pneumonia and/or pleuritis with or without lesions in other organs, and 7 (27%) cases had lesions only in organs other than the lungs (nasal mucosa, spleen, thoracic lymph nodes, heart, pericardial sac, liver, kidney, mediastinum, and/or mesentery). Pneumonia was diagnosed as the cause of death in 1,838 (9.64%) of the horses received; Coccidioides spp. was the cause of pneumonia in 19 (1.0%) of these animals. Horses have been reported to have low susceptibility to coccidioidomycosis, and the severity and chronicity of the disease can be variable. Lesions in our cases consisted of multifocal-to-coalescing pyogranulomas with intralesional fungal spherules. Coccidioidomycosis must be considered a differential diagnosis in cases of persistent cough, chronic weight loss, fever, and cases with a travel history to, or living in, a region considered endemic for coccidioidomycosis. Coccidioides spp. infection should also be considered when pyogranulomatous inflammation is found within lung, spleen, nasal mucosa, and lymph nodes of horses.
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Affiliation(s)
| | | | - Jennine Ochoa
- California Animal Health and Food Safety Laboratory, Tulare
| | | | - Francisco A Uzal
- San Bernardino Laboratories, and School of Veterinary Medicine, University of California-Davis, CA, USA
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17
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Abdollahi Zarandi P, Antony S, Sotelo-Rafiq E. A Case of Primary Osteomyelitis of the Rib With Involvement of the Chest Wall, Presenting as a Non-Healing Abscess. Cureus 2022; 14:e26974. [PMID: 35989774 PMCID: PMC9381883 DOI: 10.7759/cureus.26974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Coccidioidomycosis of the chest wall is a rare finding and diagnosis is often delayed. We report a case of chest wall abscess with underlying osteomyelitis and an expansile lytic lesion of the left fourth rib in a young and immunocompetent African American male. Initially, the diagnostic assumption gravitated towards bone malignancy, but the diagnosis of coccidioidomycosis was made when the culture results from the bone biopsy specimen confirmed Coccidioides immitis as the causative agent. The aim of this unique case is to demonstrate that as an emerging infectious agent, Coccidioides immitis is a known cause of chest wall abscess and should be considered among the differential diagnosis by clinicians.
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18
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Caceres DH, Lindsley MD. Comparison of Immunodiagnostic Assays for the Rapid Diagnosis of Coccidioidomycosis in Dogs. J Fungi (Basel) 2022; 8:jof8070728. [PMID: 35887483 PMCID: PMC9317878 DOI: 10.3390/jof8070728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
Coccidioidomycosis is a disease caused by the dimorphic fungi Coccidioides spp., which affects humans and a variety of animal species, including domestic dogs. In dogs, accurate diagnosis could provide a substantial improvement on the quality of canine life, as well as an advancement in the mapping of regions endemic for coccidioidomycosis. The purpose of this study was to compare immunodiagnostic assays for anti-Coccidioides antibody (Ab) detection in dogs’ serum. Three commercially available immunodiagnostic assays (IMMY®; Norman, OK, USA) were evaluated, including the sōna Coccidioides Ab Lateral Flow Assay (LFA), Coccidioides IDCF immunodiffusion assay (IDCF), and the Clarus Coccidioides Ab Enzyme Immunoassay (EIA). Assays were evaluated using 98 dog serum samples: 29 from dogs with coccidioidomycosis, 15 from dogs diagnosed with histoplasmosis, 10 from dogs diagnosed with blastomycosis, and 44 from dogs without a fungal disease. Using specimens from dogs with coccidioidomycosis, the IDCF had an accuracy of 92% (95% confidence interval [95% CI] = 85–96%), the EIA had an accuracy of 91% (95% CI = 83–96%), and the LFA displayed an accuracy of 82% (95% CI = 73–89%). Using Kappa analysis, the agreement between LFA and EIA was 0.59 (95% CI = 0.42–0.75), that between LFA and IDCF was 0.64 (95% CI = 0.48–0.79), and that between EIA and IDCF was 0.79 (95% CI = 0.64–0.90). Most cross-reactions were observed in dogs with histoplasmosis. Compared with EIA and IDCF, the LFA requires substantially less laboratory equipment and infrastructure and rapidly produces results, offering a substantial improvement for the initial screening of coccidioidomycosis in dogs.
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Affiliation(s)
- Diego H. Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 1653, Colombia
- Correspondence: (D.H.C.); (M.D.L.)
| | - Mark D. Lindsley
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
- Correspondence: (D.H.C.); (M.D.L.)
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Ramadan FA, Ellingson KD, Canales RA, Bedrick EJ, Galgiani JN, Donovan FM. Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA. Emerg Infect Dis 2022; 28:1091-1100. [PMID: 35608552 PMCID: PMC9155888 DOI: 10.3201/eid2806.212311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Demographic and clinical indicators have been described to support identification of coccidioidomycosis; however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected coccidioidomycosis in emergency departments and inpatient units in Coccidioides-endemic regions. We aimed to develop a predictive model among participants with suspected coccidioidomycosis. We applied a least absolute shrinkage and selection operator to specific coccidioidomycosis predictors and developed univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a statistically significant predictive feature of coccidioidomycosis in both inpatient and outpatient settings. Our multivariable outpatient model also identified rash (adjusted odds ratio 9.74 [95% CI 1.03–92.24]; p = 0.047) as a predictor. Our results suggest preliminary support for developing a coccidioidomycosis prediction model for use in clinical settings.
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20
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Pulmonary Coccidioidomycosis: A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58050655. [PMID: 35630071 PMCID: PMC9143117 DOI: 10.3390/medicina58050655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
Coccidioidomycosis is an infectious disease caused by Coccidioides immitis or C. posadasii fungus. Humans usually get infected by inhaling spores risen from the soil. Although in 60 percent of cases symptoms are absent, remaining patients can develop various manifestations of the disease, from flu-like symptoms to severe dissemination or meningitis. In endemic regions (California, Arizona, Mexico, Central, and South America), pulmonary coccidioidomycosis causes 25% of community-acquired cases of pneumonia. We present the first registered case of pulmonary coccidioidomycosis in Lithuania. Clinical presentation, pathogenesis, treatment options, and diagnostic alternatives are discussed.
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21
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Pulmonary nodules after kidney transplant. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Bagaria M, Worthington J, Magtibay PM, McCullough A, Louie M. Abdominopelvic coccidiomycosis: Diagnosis and management. J Minim Invasive Gynecol 2022; 29:1023-1025. [DOI: 10.1016/j.jmig.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
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23
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North American Endemic Fungal Infections. Radiol Clin North Am 2022; 60:409-427. [DOI: 10.1016/j.rcl.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Characterization of the Growth and Morphology of a BSL-2 Coccidioides posadasii Strain That Persists in the Parasitic Life Cycle at Ambient CO2. J Fungi (Basel) 2022; 8:jof8050455. [PMID: 35628711 PMCID: PMC9145405 DOI: 10.3390/jof8050455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
Coccidioides is a dimorphic fungus responsible for Valley Fever and is the cause of severe morbidity and mortality in the infected population. Although there is some insight into the genes, pathways, and growth media involved in the parasitic to saprophytic growth transition, the exact determinants that govern this switch are largely unknown. In this work, we examined the growth and morphology of a Coccidioides posadasii strain (C. posadasii S/E) that efficiently produces spherules and endospores and persists in the parasitic life cycle at ambient CO2. We demonstrated that C. posadasii S/E remains virulent in an insect infection model. Surprisingly, under spherule-inducing conditions, the C. posadasii S/E culture was found to be completely hyphal. Differential interference contrast (DIC) and transmission electron microscopy (TEM) revealed unexpected cellular changes in this strain including cell wall remodeling and formation of septal pores with Woronin bodies. Our study suggests that the C. posadasii S/E strain is a useful BSL-2 model for studying mechanisms underlying the parasitic to saprophytic growth transition—a morphological switch that can impact the pathogenicity of the organism in the host.
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Koutserimpas C, Naoum S, Raptis K, Vrioni G, Samonis G, Alpantaki K. Skeletal Infections Caused by Coccidioides Species. Diagnostics (Basel) 2022; 12:diagnostics12030714. [PMID: 35328269 PMCID: PMC8947487 DOI: 10.3390/diagnostics12030714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients’ mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - George Samonis
- Department of Internal Medicine, University of Crete, 71500 Heraklion, Greece
- Correspondence: ; Tel.: +30-6948712130
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Crete, 71409 Heraklion, Greece;
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Maheshwari M, Ameneni S, Athiraman H. Coccidioidomycosis Causing Hydrocephalus. Cureus 2022; 14:e21889. [PMID: 35155039 PMCID: PMC8813237 DOI: 10.7759/cureus.21889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 12/04/2022] Open
Abstract
Coccidoidomycosis is caused by Coccidoides imitis and C. posadasii infection. Coccidioidomycosis is also known as San Joaquin Valley fever or desert rheumatism. It is only seen in the Southwest United States (Arizona, New Mexico, California, Texas, Nevada, and Utah), and Central and South America. This infection is acquired by the inhalation of fungal spores in the air. The most severe extrapulmonary coccidioidomycosis is coccidioidomycosis meningitis, in which patients present with headaches, photophobia, altered mental status, and hearing difficulties. This is a case report of a person with disseminated coccidioidomycosis meningitis complicated by hydrocephalus, presenting as a headache.
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Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico. Trop Med Infect Dis 2021; 6:tropicalmed6040207. [PMID: 34941663 PMCID: PMC8705876 DOI: 10.3390/tropicalmed6040207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/03/2021] [Accepted: 11/28/2021] [Indexed: 12/21/2022] Open
Abstract
Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrates the dissemination potential of Coccidioides, the danger of unregulated pharmaceuticals, the importance of thorough history taking, and recognizing risk factors that contribute to disseminated CM.
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Thompson GR, Le T, Chindamporn A, Kauffman CA, Alastruey-Izquierdo A, Ampel NM, Andes DR, Armstrong-James D, Ayanlowo O, Baddley JW, Barker BM, Lopes Bezerra L, Buitrago MJ, Chamani-Tabriz L, Chan JFW, Chayakulkeeree M, Cornely OA, Cunwei C, Gangneux JP, Govender NP, Hagen F, Hedayati MT, Hohl TM, Jouvion G, Kenyon C, Kibbler CC, Klimko N, Kong DCM, Krause R, Lee Lee L, Meintjes G, Miceli MH, Rath PM, Spec A, Queiroz-Telles F, Variava E, Verweij PE, Schwartz IS, Pasqualotto AC. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. THE LANCET. INFECTIOUS DISEASES 2021; 21:e364-e374. [PMID: 34364529 PMCID: PMC9450022 DOI: 10.1016/s1473-3099(21)00191-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022]
Abstract
The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management.
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Affiliation(s)
- George R Thompson
- Department of Internal Medicine, Division of Infectious Disease, UC Davis Medical Center, Sacramento, CA, USA; Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA.
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Carol A Kauffman
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Neil M Ampel
- Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ, USA
| | - David R Andes
- Department of Internal Medicine, Division of Infectious Diseases, and Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | | | - Olusola Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
| | - John W Baddley
- Department of Internal Medicine, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bridget M Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Leila Lopes Bezerra
- Cellular Mycology and Proteomics Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria J Buitrago
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Leili Chamani-Tabriz
- Infectious Diseases Unit, Department of Internal Medicine, Saudi German Hospital Dubai, Dubai, UAE
| | - Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oliver A Cornely
- Department of Internal Medicine, Excellence Center for Medical Mycology, University Hospital of Cologne, Cologne, Germany; Department of Internal Medicine, Division of Infectious Diseases, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Cao Cunwei
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jean-Pierre Gangneux
- Department of Internal Medicine, Division of Infectious Diseases, Rennes University, CHU Rennes, Inserm, IRSET-UMR_S 1085, Rennes, France
| | - Nelesh P Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; Department of Internal Medicine, Division of Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands; Laboratory of Medical Mycology, Jining No 1 People's Hospital, Jining, China
| | - Mohammad T Hedayati
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tobias M Hohl
- Infectious Disease Service, Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, NY, USA; Immunology Program, Sloan Kettering Institute, New York, NY, USA
| | - Grégory Jouvion
- Sorbonne Université, INSERM, Pathophysiology of Pediatric Genetic Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - Chris Kenyon
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Nikolai Klimko
- Department of Clinical Mycology, Allergy, and Immunology, I Mechnikov North-Western State Medical University, St Petersburg, Russia
| | - David C M Kong
- Pharmacy Department, Ballarat Health Services, Ballarat, VIC, Australia; National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Low Lee Lee
- Department of Internal Medicine, Hospital Sultanah Bayiyah, Alor Setar, Kedah, Malaysia
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marisa H Miceli
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Andrej Spec
- Division of Infectious Disease, Washington University School of Medicine, St Louis, MO, USA
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ebrahim Variava
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul E Verweij
- Department of Medical Microbiology, Excellence Center for Medical Mycology, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Alessandro C Pasqualotto
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre Porto Alegre, Brazil; Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
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Yang X, Song Y, Liang T, Wang Q, Li R, Liu W. Application of laser capture microdissection and PCR sequencing in the diagnosis of Coccidioides spp. infection: A case report and literature review in China. Emerg Microbes Infect 2021; 10:331-341. [PMID: 33576325 PMCID: PMC7919914 DOI: 10.1080/22221751.2021.1889931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
Coccidioidomycosis is endemic to California, Arizona, and Mexico. In recent years, the reported cases of coccidioidomycosis have increased in nonendemic regions. Here, we reported a case of imported pulmonary coccidioidomycosis in a Chinese patient. A 63-year-old man presented with dry cough and fatigue for 6 months, and a computed tomography scan revealed a solitary nodule in the right lower lung and small nodules in both lungs. The diagnosis of coccidioidomycosis was initially confirmed by histopathologic examination. The pathogen Coccidioides spp. was identified by laser capture microdissection (LCM) combined with subsequent molecular techniques based on the positive histopathologic features. Additionally, we reviewed 47 reported cases of coccidioidomycosis in China. The number of reported cases is increasing, and the incidence of disseminated infection has exhibited a trend of shifting towards healthy young adults in China. Since clinical presentations and imaging findings lack specificity, a majority of domestic cases of coccidioidomycosis were initially misdiagnosed as tumours or tuberculosis. Moreover, the diagnosis of endemic mycoses may be challenging because of their rarity and the limited availability of diagnostic tests. The diagnosis was mainly confirmed by histopathological examination. The species involved were identified based on positive cultures in only 4 cases. To our knowledge, this is the first study to use LCM and molecular techniques to identify Coccidioides spp. in the histopathologically positive but uncultivable specimen. Comparing with previous reported studies, LCM combined with nucleic acid amplification techniques improve the ability of species identification for the timely diagnosis of coccidioidomycosis.
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Affiliation(s)
- Xinyu Yang
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yinggai Song
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
| | - TianYu Liang
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
| | - Qiqi Wang
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
| | - Ruoyu Li
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
| | - Wei Liu
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
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Singh R, Srinivasan VM, Catapano JS, DiDomenico JD, Baranoski JF, Lawton MT. Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21424. [PMID: 35855060 PMCID: PMC9265202 DOI: 10.3171/case21424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND
Coccidioidomycosis is a primarily self-limiting fungal disease endemic to the western United States and South America. However, severe disseminated infection can occur. The authors report a severe case of coccidioidal meningitis that appeared to be a subarachnoid hemorrhage (SAH) on initial inspection.
OBSERVATIONS
A man in his early 40s was diagnosed with coccidioidal pneumonia after presenting with pulmonary symptoms. After meningeal spread characterized by declining mental status and hydrocephalus, coccidioidal meningitis was diagnosed. The uniquely difficult aspect of this case was the deceptive appearance of SAH due to the presence of multiple aneurysms and blood draining from the patient’s external ventricular drain.
LESSONS
Coccidioidal infection likely led to the formation of multiple intracranial aneurysms in this patient. Although few reports exist of coccidioidal meningitis progressing to aneurysm formation, patients should be closely monitored for this complication because outcomes are poor. The presence of basal cistern hyperdensities from a coccidioidal infection mimicking SAH makes interpreting imaging difficult. Surgical management of SAH can be considered safe and viable, especially when the index of suspicion is high, such as in the presence of multiple aneurysms. Even if it is unclear whether aneurysmal rupture has occurred, prompt treatment is advisable.
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Affiliation(s)
- Rohin Singh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Visish M. Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Joseph D. DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Jacob F. Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Less common bacterial, fungal and viral infections: review of management in the pregnant patient. Drugs Context 2021; 10:dic-2021-4-3. [PMID: 34603460 PMCID: PMC8462995 DOI: 10.7573/dic.2021-4-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022] Open
Abstract
This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.
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Affiliation(s)
| | - Hana R Winders
- University of South Carolina College of Pharmacy, Columbia, SC, USA.,Prisma Health Midlands, Columbia, SC, USA
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | | | - Brooke Griffin
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | | | - Lea S Eiland
- Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Milena Murray
- Midwestern University College of Pharmacy, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
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Mao Y, Li X, Lou H, Shang X, Mai Y, Yang L, Peng F, Fu X. Detection of Coccidioides posadasii in a patient with meningitis using metagenomic next-generation sequencing: a case report. BMC Infect Dis 2021; 21:968. [PMID: 34535093 PMCID: PMC8447723 DOI: 10.1186/s12879-021-06661-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coccidioidomycosis is a systemic infection caused by dimorphic fungi Coccidioides spp. endemic to Southwestern United States and Central and South America. A history of residence and travel in these areas is essential for the diagnostic of coccidioidomycosis, which has highly variable symptoms ranging from asymptomatic to severe, disseminated infection, and even death. Immunocompromised patients of coccidioidomycosis experience a high risk of dissemination, chronic infection, and mortality. Meningitis is one of the most deleterious coccidioidomycosis and can cause various life-threatening complications. CASE PRESENTATION Here we report a case of Coccidioides posadasii meningitis in a 49-year-old female who returned to China after one and a half years residence in Los Angeles, USA. The repeated routine cultures using CSF for bacteria or fungi were all negative. To hunt for an infectious etiology, the state-of-the-art technology metagenomic next-generation sequencing (mNGS) was then utilized, suggesting Coccidioides posadasii. Organizational pathological examination and polymerase-chain-reaction (PCR) results subsequently confirmed the mNGS detection. CONCLUSION To our knowledge, cases for coccidioidal meningitis have been rarely reported in China. While global travelling may spread this disease across continents and make the diagnosis more difficult. mNGS can detect almost all known pathogens with high sensitivity and specificity, especially for uncommon pathogen, such as Coccidioides posadasii in China.
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Affiliation(s)
- Yuqiao Mao
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Xia Li
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Haibo Lou
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Xiaoyu Shang
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yanjun Mai
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Lan Yang
- Department of Bioinformatics, Hugobiotech Co., Ltd., Beijing, China
| | - Fuhua Peng
- Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Xihua Fu
- Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China.
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Villar-Prados A, Chang JJ, Stevens DA, Schoolnik GK, Wang SXY. Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special. J Fungi (Basel) 2021; 7:jof7080620. [PMID: 34436160 PMCID: PMC8397024 DOI: 10.3390/jof7080620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole’s mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.
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Affiliation(s)
| | - Julia J. Chang
- Division of Endocrinology, Metabolism, and Gerontology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - David A. Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.A.S.); (G.K.S.)
- California Institute of Medical Research, San Jose, CA 95128, USA
| | - Gary K. Schoolnik
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.A.S.); (G.K.S.)
| | - Samantha X. Y. Wang
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-650-721-8900
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Balderas-Sosa EY, De la Torre JL, Soualhi A, Leyva-Moraga FA, Leyva-Moraga F, Leyva-Moraga E. Coccidioidomycosis mimicking testicular cancer: A case report. Andrologia 2021; 53:e14151. [PMID: 34170025 DOI: 10.1111/and.14151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
We present the case of a 48 year-old man with a history of pulmonary tuberculosis who was brought to our centre with a progressively increasing left testicular mass. Radiological findings were not conclusive on whether the mass was neoplastic or infectious in nature. Therefore, an orchiectomy was performed. Pathology examination revealed coccidioidomycosis of the left testicle, highlighting an exceedingly rare presentation of disseminated genitourinary coccidioidomycosis.
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Affiliation(s)
| | - Jose L De la Torre
- Servicio de Imagenología, Hospital General del Estado de Sonora, Hermosillo, México
| | - Ahmed Soualhi
- GKT School of Medical Education, King's College London, London, UK
| | | | - Fernando Leyva-Moraga
- Department of Medicine and Health Science, Universidad de Sonora, Hermosillo, México
| | - Eduardo Leyva-Moraga
- Department of Medicine and Health Science, Universidad de Sonora, Hermosillo, México
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Davis MR, Chang S, Gaynor P, McCreary EK, Allyn P. Isavuconazole for treatment of refractory coccidioidal meningitis with concomitant cerebrospinal fluid and plasma therapeutic drug monitoring. Med Mycol 2021; 59:939-942. [PMID: 34143187 DOI: 10.1093/mmy/myab035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
Coccidioidal meningitis (CM) is a life-threatening infection with limited treatment options. Small series have reported success with isavuconazole; however, limited data exist on cerebrospinal fluid (CSF) penetration. Paired plasma and CSF isavuconazole concentrations were measured. Eleven CSF levels were tested, (7 ventricular, 4 lumbar) in three CM patients. Ventricular CSF levels were undetectable despite detectable plasma levels. All lumbar CSF levels were detectable (mean 1.00 µg/mL). Three pairs of lumbar CSF/plasma concentrations taken within one hour of each other yielded a mean CSF/plasma ratio of 0.31. Isavuconazole was detectable in lumbar but not ventricular CSF in three patients treated for refractory CM.
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Affiliation(s)
- Matthew R Davis
- Department of Pharmacy, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, California
| | - Sandy Chang
- Division of Infectious Diseases, Department of Internal Medicine, University of California Ronald Reagan Los Angeles Medical Center, Los Angeles, California
| | - Pryce Gaynor
- Division of Infectious Diseases, Department of Internal Medicine, University of California Ronald Reagan Los Angeles Medical Center, Los Angeles, California
| | - Erin K McCreary
- Division of Infectious Diseases, Department of Medicine, UPMC, Pittsburgh, PA, USA
| | - Paul Allyn
- Division of Infectious Diseases, Department of Internal Medicine, University of California Ronald Reagan Los Angeles Medical Center, Los Angeles, California
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Abstract
Coccidioidomycosis, caused by the dimorphic pathogenic fungi Coccidioides immitis and Coccidioides posadassi, is endemic to the southwestern United states and Central and South America. The incidence of coccidioidomycosis continues to increase. Coccidioidomycosis is typically a self-limiting influenza-like respiratory illness; however, it can lead to disseminated disease outside of the lungs. Not all nondisseminated cases require therapy, but antifungal therapy is typically beneficial requiring treatment ranging from months to lifelong. Clinical factors related to treatment decisions include severity of symptoms, radiography, coccidioidomycosis serologic results, and concurrent medical problems including immunosuppression. This review summarizes the epidemiology, clinical manifestations, and treatment options.
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Affiliation(s)
- Derek J Bays
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA; Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA.
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Kovanda LL, Sass G, Martinez M, Clemons KV, Nazik H, Kitt TM, Wiederhold N, Hope WW, Stevens DA. Efficacy and Associated Drug Exposures of Isavuconazole and Fluconazole in an Experimental Model of Coccidioidomycosis. Antimicrob Agents Chemother 2021; 65:e02344-20. [PMID: 33782009 PMCID: PMC8316117 DOI: 10.1128/aac.02344-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/14/2021] [Indexed: 12/19/2022] Open
Abstract
Coccidioides spp. are important pathogens in regions where they are endemic, and new treatment options are needed. Here, isavuconazonium sulfate (ISAVUSULF) and fluconazole (FLU) were evaluated in experimental disseminated coccidioidomycosis to characterize drug exposures associated with efficacy. Broth macrodilution was performed on Coccidioides isolates to measure minimal effective concentrations (MEC) and minimal fungicidal concentrations (MFC). Mice were inoculated with Coccidioides posadasii (Silveira strain). Treatment started 4 days postinoculation. In model 1, mice were treated for 19 days, followed by 30 days of off-therapy observation, measuring survival through day 49 and residual fungal burden. Treatments included ISAVUSULF (prodrug; 186, 279, or 372 mg/kg twice daily), FLU (20 or 100 mg/kg once daily), and no treatment. Model 2 included 7-day treatment with ISAVUSULF (prodrug; 74.4, 111.6, or 148.8 mg/kg twice daily), FLU (20 or 100 mg/kg once daily), and no treatment. Serial plasma and tissues samples were obtained for pharmacokinetics (PK) and fungal burden measurement, respectively. Fifty percent minimal effective concentration (MEC50) values were 0.39 mg/liter (isavuconazole [ISAV]) and 12.5 mg/liter (FLU). Treatment with ISAVUSULF186 or with either FLU dose resulted in higher survival compared to that in the untreated group. Treatment with ISAVUSULF186 or ISAVUSULF279 twice daily or FLU100 reduced fungal burden in all organs (model 1). In model 2, a >1 log10 CFU/organ reduction was demonstrated, with ISAV area under the concentration-time curve (AUC) values achieved with 111.6 mg/kg twice daily (56.8 mg · h/liter) in the spleen and liver. FLU AUC values of 100 and 500 mg·h/liter for 20 and 100 mg/kg doses, respectively, resulted in a >1 log10 CFU/organ mean reduction in all organs. ISAVUSULF and FLU improved survival and reduced fungal burden. Increasing plasma drug exposures resulted in decreases in fungal burden.
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Affiliation(s)
- Laura L Kovanda
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | - Karl V Clemons
- California Institute for Medical Research, San Jose, California, USA
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA
| | - Therese M Kitt
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | - Nathan Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - William W Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospital Trust, Liverpool Health Partners, Liverpool, United Kingdom
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA
- Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, USA
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Disseminated coccidioidomycosis in an immunocompetent patient. Int J Infect Dis 2021; 107:228-231. [PMID: 33940191 DOI: 10.1016/j.ijid.2021.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
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De la Cerda-Vargas MF, Sandoval-Bonilla BA, McCarty JM, De León FCP, Candelas-Rangel JA, Rodríguez-Rodríguez JD, Navarro-Domínguez P, Muñoz-Hernández MA, Meza-Mata E, Fernández-González EM, Sámano-Aviña MG. Hydrocephalus in Mexican children with Coccidioidal Meningitis: Clinical, serological, and neuroimaging findings. Surg Neurol Int 2021; 12:119. [PMID: 33880224 PMCID: PMC8053472 DOI: 10.25259/sni_895_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/08/2021] [Indexed: 01/03/2023] Open
Abstract
Background Coccidioidal meningitis (CM) is a fungal infectious disease that rarely affects children. Even in endemic areas, coccidiomycosis rarely affects the pediatric population. However, 40% of affected children develop hydrocephalus. Here, we describe the clinical, serological, and neuroimaging findings in a series of Mexican children admitted to our neurosurgical service with hydrocephalus and subsequently diagnosed with CM. Methods We report a prospective series of pediatric patients with hydrocephalus secondary to CM in an endemic area at the north of Mexico. Our report includes children with CM who were hospitalized from 2015 to 2019 in a regional hospital in Torreón, Coahuila. Clinical evolution was monitored for 1 year after hospital discharge. Results Our series include five children with CM (2-17-years-old, three female), who were hospitalized for hydrocephalus and developed intracranial hypertension. The most frequent neuroimaging findings were leptomeningeal enhancement (5/5) and basal arachnoiditis (4/5), followed by asymmetric hydrocephalus (3/5), abnormalities in fourth ventricle morphology (3/5), and cerebral vasculitis (2/5). CM was diagnosed by positive serology or pathology studies. All children were initially managed with fluconazole and a shunt was placed for management of hydrocephalus. Four patients recovered without permanent neurological deficits and one subject developed persistent vegetative state. One year after hospital discharge, none of the subjects died. Conclusion This series contributes to the limited number of pediatric CM cases reported in the literature, and describes neuroimaging findings in the pediatric population. The cases here presented show that the identification of Coccidioides as causal agent in pediatric meningitis is crucial for targeted treatment and can affect dramatically neurological prognosis. Furthermore, our report stresses that even in endemic areas pediatric coccidiomycosis represents a diagnostic challenge, which is further exacerbated by the limited availability of resources in these regions. Therefore, a positive immunoglobulin G by enzyme immunoassay is enough for diagnosis of CM in endemic areas without access to CF.
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Affiliation(s)
- María F De la Cerda-Vargas
- Department of Neurosurgery, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - B A Sandoval-Bonilla
- Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - James M McCarty
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, United States
| | | | - José A Candelas-Rangel
- Department of Neurosurgery, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Jorge D Rodríguez-Rodríguez
- Department of Neurosurgery, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Pedro Navarro-Domínguez
- Department of Neurosurgery, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Melisa A Muñoz-Hernández
- Department of Health Education and Research, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Elizabeth Meza-Mata
- Department of Anatomycal Pathology, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Elena M Fernández-González
- Department of Health Education, Hospital de Especialidades N° 71, Instituto Mexicano del Seguro Social, Torreón Coahuila
| | - Mariana G Sámano-Aviña
- Department of Pediatric Infectious Disease, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
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Kunin JR, Blasco LF, Hamid A, Fuss C, Sauer D, Walker CM. Thoracic Endemic Fungi in the United States: Importance of Patient Location. Radiographics 2021; 41:380-398. [PMID: 33544664 DOI: 10.1148/rg.2021200071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The digitization of radiographic studies along with high-speed transmission of images has formed the basis of teleradiology, which has become an integral component in the workflow of a contemporary radiology practice. It is with this advent and growing utilization of teleradiology that the significance of the source location of images has gained importance. Specifically, the importance of where the patient resides and what endemic fungi occur in that location cannot be underestimated. In the United States, histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis are caused by endemic fungi occurring in the Ohio and Mississippi river valleys, the Southwest, the Upper Midwest, and the Pacific Northwest, respectively. All of these organisms enter the body through the respiratory system and have the potential to cause significant morbidity and mortality. Patients infected with these fungi are often asymptomatic but may present with acute flulike symptoms such as fever, cough, or dyspnea. Patients may also present with vague chronic symptoms including cough, fever, malaise, and weight loss. Thoracic manifestations at radiography and CT include consolidation, nodules, cavities, lymphadenopathy, and pleural disease. PET may show fluorine 18-fluorodeoxyglucose uptake with active acute or chronic infections, and it is difficult to distinguish infections from malignancy. Imaging findings may be nonspecific and can be confused with other disease processes, including malignancy. The patient demographics, clinical history, and location are clues that may lead to a proper diagnosis of endemic fungal disease. The radiologist should be cognizant of the patient location to provide a correct and timely radiologic diagnosis that helps guide the clinician to initiate appropriate therapy. ©RSNA, 2021.
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Affiliation(s)
- Jeffrey R Kunin
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
| | - Lucia Flors Blasco
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
| | - Aws Hamid
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
| | - Cristina Fuss
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
| | - David Sauer
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
| | - Christopher M Walker
- From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.)
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Cordeiro R, Moura S, Castelo-Branco D, Rocha MF, Lima-Neto R, Sidrim JJ. Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease. J Fungi (Basel) 2021; 7:85. [PMID: 33513773 PMCID: PMC7911456 DOI: 10.3390/jof7020085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.
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Affiliation(s)
- Rossana Cordeiro
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Santiago Moura
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Débora Castelo-Branco
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Marcos Fábio Rocha
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
- Postgraduate Program in Veterinary Sciences, School of Veterinary Medicine, Ceará State University, Fortaleza 60740-000, Brazil
| | - Reginaldo Lima-Neto
- Center of Medical Sciences, Department of Tropical Medicine, Federal University of Pernambuco (UFPE), Recife-PE 50740-600, Brazil
| | - José Júlio Sidrim
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
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Mafi N, Murphy CB, Girardo ME, Blair JE. Coccidioides (spherulin) skin testing in patients with pulmonary coccidioidomycosis in an endemic region†. Med Mycol 2021; 58:626-631. [PMID: 31578560 DOI: 10.1093/mmy/myz099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 01/06/2023] Open
Abstract
Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. Intact cellular immunity is critical to the control of this infection. A recently released reformulated spherulin antigen (Spherusol; Nielsen BioSciences, Inc.) was approved to detect delayed-type hypersensitivity, which implies the presence of cellular immunity, to Coccidioides species. We aimed to summarize our experience with this test in patients with primary pulmonary coccidioidomycosis. We retrospectively reviewed clinical data for all patients with primary pulmonary coccidioidomycosis who had a Coccidioides (spherulin) skin test (CST) placed at our institution between January 1, 2015, and August 31, 2017. During the study period, 172 patients had a CST placed, and 122 met our inclusion criteria for proven or probable pulmonary coccidioidomycosis. Of these 122, 88 (72.1%) had a positive CST result and 34 (27.9%) had a negative result. In the positive CST group, 74 of the 79 treated patients (93.7%) had antifungal treatment stopped, 1 of whom (1.4%) had relapsed infection. In contrast, 27 of the 33 treated patients in the negative CST group (81.8%) had their antifungal treatment stopped, and none had a relapse. Seven patients overall (5.7%), all of whom had a positive CST, experienced mild local adverse reactions to the CST. Although previous controlled studies of CST showed sensitivity and specificity greater than 98%, our real-world experience with the CST showed lower rates of positivity. Negative CST results did not predict relapse with antifungal agent withdrawal.
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Affiliation(s)
- Neema Mafi
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Marlene E Girardo
- Biostatistics, Mayo Clinic, Scottsdale, Arizona. Dr. Mafi is now in private practice in Scottsdale, Arizona
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona
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43
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Khatib A, Mukkala AN, Chong-Kit T, Raheel H, Boggild AK. Erythema Nodosum and a Cavitary Lung Lesion in a Febrile Returned Traveler from Arizona: a Case of Coccidioidomycosis. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-020-00745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Arffa M, Leszczynska MA, Krishnan C, Diaz LZ. Ulcerated plaques on the hands. Pediatr Dermatol 2021; 38:e7-e9. [PMID: 33630374 DOI: 10.1111/pde.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew Arffa
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Maria A Leszczynska
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Chandra Krishnan
- Department of Pathology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
| | - Lucia Z Diaz
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
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45
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Tirado-Sánchez A, Franco-Paredes C, Bonifaz A. Subcutaneous Mycoses in Travelers. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:141-152. [PMID: 35665217 PMCID: PMC9162435 DOI: 10.1007/s40475-020-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
Purpose of Review The increase in international travel in recent decades has contributed to the risk of acquiring diseases considered endemic to a region or country and the change in the epidemiology of these diseases. Endemic mycoses that may be acquired by travelers in the short or long term are endemic subcutaneous mycoses such as sporotrichosis and lobomycosis, while endemic systemic mycoses are a group of serious diseases including histoplasmosis and coccidioidomycosis. Herein, we review the current knowledge and highlight the most important aspects of these fungal infections in travelers. Recent Findings The most relevant advances in the study of these mycoses involve the epidemiological distribution; human mycoses can be fatal and there are few antifungal drugs available, increasing drug resistance, and a risk of emerging fungal diseases associated with climate change, as well as the increasing virulence, and the diagnostic strategies that may be limited in many countries. Summary Although endemic mycoses are relatively rare, they should be considered as potentially travel-related illnesses. A recent or late trip to an endemic country may guide the clinical suspicion, an early diagnosis, and the institution of effective therapy.
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Affiliation(s)
- Andrés Tirado-Sánchez
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, Anschutz Medical Center, University of Colorado, Aurora, CO, USA
- Instituto Nacional de Salud, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Alexandro Bonifaz
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
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46
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Bajwa AK, Rongkavilit C. Update on Coccidioidomycosis in the United States and Beyond. Glob Pediatr Health 2020; 7:2333794X20969282. [PMID: 33241083 PMCID: PMC7675861 DOI: 10.1177/2333794x20969282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Coccidioidomycosis is a fungal infection that is prevalent in western United States, Central America, and South America. The infection is acquired by inhalation. It can affect persons of all ages including infants and children. The majority of cases are asymptomatic and the incidence of infection is greater during a dry summer season after heavy rainfall in prior winter. For those with symptoms, they may experience a self-limiting influenza-like illness. However, some may progress toward pneumonia or disseminated diseases involving skeletal system and central nervous system. The diagnosis is based mainly on various serology testing. Antifungal treatment is generally not required for those with mild symptoms. For those with moderate to severe infections, the mainstay of treatment is azole, with fluconazole being often considered as the first line therapy. Currently there is no effective solution to prevent coccidioidomycosis. Those who work in high-risk conditions should be given appropriate protective equipment as well as education on proper precaution.
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Affiliation(s)
- Alisha K. Bajwa
- University of California San Francisco, Fresno Branch, Fresno, CA, USA
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Reyna-Rodríguez IL, Ocampo-Candiani J, Chavez-Alvarez S. Primary Cutaneous Coccidioidomycosis: An Update. Am J Clin Dermatol 2020; 21:681-696. [PMID: 32557380 DOI: 10.1007/s40257-020-00525-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coccidioidomycosis is an endemic mycosis of the southern United States, Northern Mexico, and South America. Primary cutaneous coccidioidomycosis, despite being a very rare clinical presentation, has shown an increasing incidence. An extensive literature search for cutaneous coccidioidomycosis cases was performed using the OLDMEDLINE, PubMed, Cochrane, LILACS and Google Scholar databases for studies published from January 1927 through December 21, 2019. Forty-two observational studies were included totaling 82 cases of primary cutaneous coccidioidomycosis. Narrative reviews, systematic reviews, and meta-analyses were also included. Additionally, an original case was included. Patients with primary cutaneous coccidioidomycosis share the same geographical and epidemiological characteristics as those with pulmonary or disseminated coccidioidomycosis. Most of the imported cases came from endemic areas. A large portion of cases had prior local skin trauma. Tissue culture is still the leading diagnostic method; nevertheless, molecular techniques such as polymerase chain reaction (PCR) are currently relevant to differentiate between species. First-line treatment consists of azoles; however, it has an excellent prognosis even without treatment. Primary cutaneous coccidioidomycosis should be considered a differential diagnosis of unusual infections or neoformations in any part of the body in resident populations of endemic areas or in patients with a previous history of travel to these areas.
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Affiliation(s)
- Irving Llibran Reyna-Rodríguez
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico
| | - Sonia Chavez-Alvarez
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico.
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Gabriel A, Mu A. A 42-Year-Old Man With Lingual Nodules and a Headache. Clin Infect Dis 2020; 69:1827-1829. [PMID: 31665756 DOI: 10.1093/cid/ciy1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Gabriel
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland
| | - Anandit Mu
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, California
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Peng T, Zong Y, Johnson MD, Menghani SV, Lewis ML, Galgiani JN. A quantitative enzyme-linked immunoassay (ELISA) to approximate complement-fixing antibody titers in serum from patients with coccidioidomycosis. Diagn Microbiol Infect Dis 2020; 99:115198. [PMID: 32987245 DOI: 10.1016/j.diagmicrobio.2020.115198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/26/2023]
Abstract
Coccidioidomycosis is most frequently diagnosed serologically, and the quantitative test for complement-fixing antibodies is considered prognostically useful. Because complement-fixing antibody testing is complex, labor-intensive, and poorly standardized, an enzyme-linked immunoassay (ELISA) alternative would be attractive. In this report, we restrict the complement-fixing, antibody-binding domain to a 200-amino-acid recombinant peptide of the known antigen. Over-lapping truncations of this peptide do not bind complement-fixing antibodies, suggesting that the responsible epitope(s) are conformational. Further, anchoring the antigenic peptide to the ELISA plate by means of a C-terminal biotin-mimic peptide tag instead of allowing the peptide to randomly adhere to the plastic plate improves sensitivity of antibody detection by 1-2 logs in different sera. The newly developed ELISA shows a significant quantitative correlation with complement-fixing antibody titers. This ELISA shows potential as the basis for a new quantitative assay for coccidioidal antibodies.
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Affiliation(s)
- Tao Peng
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ
| | - Yue Zong
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ
| | - Michael Dl Johnson
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ; Department of Immunobiology, University of Arizona, Tucson, AZ; BIO5 Institute, University of Arizona, Tucson, AZ
| | | | | | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ; BIO5 Institute, University of Arizona, Tucson, AZ; Department of Medicine, University of Arizona, Tucson, AZ.
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Kischkel B, Rossi SA, Santos SR, Nosanchuk JD, Travassos LR, Taborda CP. Therapies and Vaccines Based on Nanoparticles for the Treatment of Systemic Fungal Infections. Front Cell Infect Microbiol 2020; 10:463. [PMID: 33014889 PMCID: PMC7502903 DOI: 10.3389/fcimb.2020.00463] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Treatment modalities for systemic mycoses are still limited. Currently, the main antifungal therapeutics include polyenes, azoles, and echinocandins. However, even in the setting of appropriate administration of antifungals, mortality rates remain unacceptably high. Moreover, antifungal therapy is expensive, treatment periods can range from weeks to years, and toxicity is also a serious concern. In recent years, the increased number of immunocompromised individuals has contributed to the high global incidence of systemic fungal infections. Given the high morbidity and mortality rates, the complexity of treatment strategies, drug toxicity, and the worldwide burden of disease, there is a need for new and efficient therapeutic means to combat invasive mycoses. One promising avenue that is actively being pursued is nanotechnology, to develop new antifungal therapies and efficient vaccines, since it allows for a targeted delivery of drugs and antigens, which can reduce toxicity and treatment costs. The goal of this review is to discuss studies using nanoparticles to develop new therapeutic options, including vaccination methods, to combat systemic mycoses caused by Candida sp., Cryptococcus sp., Paracoccidioides sp., Histoplasma sp., Coccidioides sp., and Aspergillus sp., in addition to providing important information on the use of different types of nanoparticles, nanocarriers and their corresponding mechanisms of action.
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Affiliation(s)
- Brenda Kischkel
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Suélen A Rossi
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Samuel R Santos
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Joshua D Nosanchuk
- Departments of Medicine [Division of Infectious Diseases], Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Luiz R Travassos
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos P Taborda
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
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