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Korsten K, Altenburg J, Gittelbauer M, van Hengel P, Jansen R, van Dijk K. Coccidioidomycosis presenting years after returning from travel. Med Mycol Case Rep 2024; 43:100623. [PMID: 38283388 PMCID: PMC10818180 DOI: 10.1016/j.mmcr.2023.100623] [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] [Received: 11/09/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
After having traveled to California in 2017, a 26-year old Dutch man presented in 2020 with persisting cough and shortness of breath. Radiology showed cystic bronchiectasis with peri-bronchial consolidation in his right upper lobe. Laboratory studies in August 2021 showed an increased total IgE, specific Aspergillus IgE, eosinophilia and positive BAL culture for Coccidioides immitis/posadasii. After 6 weeks of itraconazole treatment for suspected allergic bronchopulmonary aspergillosis, symptoms persisted and respiratory cultures remained positive. The infection was cleared after a 6-month course of fluconazole. (max 75 words).
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Affiliation(s)
- Koos Korsten
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, the Netherlands
| | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marieke Gittelbauer
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peter van Hengel
- Department of Pulmonary Diseases, Flevo Hospital, Almere, the Netherlands
| | - Rogier Jansen
- Department of Medical Microbiology, OLVG, Amsterdam, the Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, the Netherlands
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2
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De la Cerda-Vargas MF, Candelas-Rangel JA, Navarro-Dominguez P, Sandoval-Bonilla BA, Meza-Mata E, Muñoz-Hernandez MA, Segura-Lopez FK, Ramirez-Silva LH, Gonzalez-Martinez MDR, Delgado-Aguirre HA. Neurococcidiomycosis in children with hydrocephalus: assessment of functional outcome, quality of life and survival in relation to neuroimaging findings. Childs Nerv Syst 2024; 40:303-319. [PMID: 37819508 DOI: 10.1007/s00381-023-06166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Coccidioidal meningitis (CM) is an uncommon disease frequently misdiagnosed. Neuroimaging and mortality are not considered in detail in previous pediatric CM series. Our objective is to evaluate outcome of pediatric neurococcidiomycosis in relation to neuroimaging findings. METHODS We performed a prospective, observational, cross-sectional study in children with hydrocephalus and CM treated at Specialties Hospital in Torreon, Mexico (between 2015 and 2020). The outcome was evaluated by Hydrocephalus Outcome Questionnaire (HOQ) and the modified Rankin Scale (mRS). Follow-up was established at the first shunt surgery and survival since CM diagnosis confirmation. Neuroimaging was analyzed in relation to clinical data, outcome and survival. Kaplan-Meier analysis was performed with IBM-SPSS-25. RESULTS Ten pediatric cases with CM and hydrocephalus were reported. Aged 6-228 months, 60% were female. Mean number of surgeries was 4.3 SD ± 3 (range 1-15). Asymmetric hydrocephalus was the most common neuroimaging finding (70%), followed by cerebral vasculitis (20%) and isolated fourth ventricle (IFV) (20%). The mean HOQ overall score was 0.338 SD ± 0.35. A minimum follow-up of 18 months was reported. Mean survival was 13.9 SD ± 6.15 months (range 3-24). Poor survival was correlated with asymmetric hydrocephalus (p = 0.335), cerebral vasculitis (p = 0.176), IFV (p < 0.001), bacterial superinfection (p = 0.017), lower mRS scores at hospital discharge (p = 0.017) and during follow-up (p = 0.004). The mortality rate was 20%. CONCLUSIONS We report the largest series in Latin America of pediatric CM and hydrocephalus. Asymmetric hydrocephalus, IFV and cerebral vasculitis are complications that increase mortality and must be early diagnosed for a timely surgical and medical treatment. HOQ and mRS could be alternative scales to evaluate outcome in these patients. After a long follow-up (18 months), survival remained poor after diagnosis confirmation in our series.
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Affiliation(s)
- Maria F De la Cerda-Vargas
- Department of Neurosurgery and Neurotechnologie, Universitätsklinik Tübingen, Tübingen, Germany.
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico.
| | - Jose A Candelas-Rangel
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
- Department of Neurosrugery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Pedro Navarro-Dominguez
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Bayron A Sandoval-Bonilla
- Associated Professor, Department of Neurosurgery, Specialties Hospital, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elizabeth Meza-Mata
- Head of Anatomical Pathology Department, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Melisa A Muñoz-Hernandez
- Department of Health and Research, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - F K Segura-Lopez
- Department of Health and Research, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Luis H Ramirez-Silva
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | | | - Hector A Delgado-Aguirre
- Department of Transplants, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
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3
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Ferguson AJ, Thompson GR, Bruyette D, Sykes JE. The dog as a sentinel and animal model for coccidioidomycosis. Med Mycol 2024; 62:myad139. [PMID: 38148116 DOI: 10.1093/mmy/myad139] [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] [Received: 10/15/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 12/28/2023] Open
Abstract
Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change-along with predicted population increases and increased development in the southwest United States-may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.
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Affiliation(s)
- Adam J Ferguson
- Department of Biological Sciences, University of California-San Diego, La Jolla, USA
| | - George R Thompson
- Department of Internal Medicine - Division of Infectious Diseases, University of California-Davis, Davis, USA
| | | | - Jane E Sykes
- Department of Medicine & Epidemiology, University of California-Davis, Davis, USA
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4
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Hayashi G, Pardo N, Hirsh NM, Vijayan V. Orbital Osteomyelitis and Periorbital Abscess Due to Coccidioidomycosis Following Trauma. Cureus 2023; 15:e46586. [PMID: 37933359 PMCID: PMC10625754 DOI: 10.7759/cureus.46586] [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: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Ocular involvement due to Coccidioides sp.is extremely rare, and most patients with disseminated coccidioidomycosis present as extrapulmonary or disseminated disease that involves the skin, bone joints, and central nervous system. Here, we describe a 13-year-old previously healthy Black male residing in an area endemic for coccidioidomycosis. The child presented to our hospital with left eye pain, diplopia, and proptosis two weeks after being struck on the left side of the face with a basketball. He was initially presumed to have bacterial orbital cellulitis and was started on empiric antibiotics. Due to severe disease, he underwent surgical drainage and debridement. Fungal stain from the intraoperative specimen showed spherules with endosporulation, and fungal culture revealed Coccidioides immitis. Based on this, the child was diagnosed with orbital osteomyelitis and periorbital abscess due to coccidioidomycosis. He was started on intravenous liposomal amphotericin B and fluconazole. Antibiotics were discontinued. He underwent additional investigations to assess for sites of dissemination. His nuclear medicine bone scintigraphy and cerebrospinal fluid studies were negative. A computed tomography (CT) scan of the chest demonstrated multiple small pulmonary nodules. His Coccidioides complement fixation(CF) titer was 1:32. The patient completed one month of treatment with liposomal amphotericin B and fluconazole. Our case highlights the need for healthcare professionals to consider coccidioidomycosis when evaluating patients with orbital disease as delays in the diagnosis may result in visual loss and central nervous system involvement. Prompt diagnosis, evaluation, and treatment are crucial to reduce long-term morbidity and mortality.
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Affiliation(s)
- Garrick Hayashi
- Department of Pediatrics, Valley Children's Healthcare, Madera, USA
| | - Natalie Pardo
- Department of Pediatrics, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Nurit M Hirsh
- Department of Pediatrics, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Vini Vijayan
- Department of Pediatrics, Valley Children's Healthcare, Madera, USA
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5
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Naeem F, McCarty J, Rowe MR, Davis AW, Tablizo MA, Hady KK, Vijayan V. Pediatric Laryngeal Coccidioidomycosis: A Case Series in an Endemic Region. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00446. [PMID: 37200514 DOI: 10.1097/inf.0000000000003961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted this study to review the characteristics of laryngeal coccidioidomycosis in children. METHODS We performed a retrospective review of patients ≤21 years of age with laryngeal coccidioidomycosis who were treated from January 2010 to December 2017. We collected demographic data, clinical and laboratory studies and patient outcomes. RESULTS Five cases of pediatric laryngeal coccidioidomycosis were reviewed. All children were Hispanic and 3 were female. The median age was 1.8 years and the median duration of symptoms before diagnosis was 24 days. The most common symptoms included fever (100%), stridor (60%), cough (100%) and vocal changes (40%). Airway obstruction requiring tracheostomy and/or intubation for airway management was present in 80%. The most frequent location of lesions was the subglottic area. Coccidioidomycosis complement fixation titers were frequently low and culture/histopathology of laryngeal tissue was necessary to make a definitive diagnosis. All patients required surgical debridement and were treated with antifungal agents. None of the patients had recurrence during the follow-up period. CONCLUSIONS This study suggests that laryngeal coccidioidomycosis in children presents with refractory stridor or dysphonia and severe airway obstruction. Favorable outcomes can be achieved with a comprehensive diagnostic work-up and aggressive surgical and medical management. With the rise in cases of coccidioidomycosis, physicians should have a heightened awareness regarding the possibility of laryngeal coccidioidomycosis when encountering children who have visited or reside in endemic areas with stridor or dysphonia.
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Affiliation(s)
- Fouzia Naeem
- From the Division of Infectious Disease, Department of Pediatrics, Valley Children's Healthcare, Madera, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - James McCarty
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Mark R Rowe
- Division of Otolaryngology, Department of Pediatrics, Valley Children's Healthcare, Madera, California
| | - Amy W Davis
- Department of Pathology and Laboratory Medicine, Valley Children's Healthcare, Madera, California
| | | | | | - Vini Vijayan
- From the Division of Infectious Disease, Department of Pediatrics, Valley Children's Healthcare, Madera, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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6
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7
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A 28-Year-Old Man With Diffuse Bilateral Pulmonary Nodules. Chest 2022; 162:e9-e13. [DOI: 10.1016/j.chest.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
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8
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Hernandez Lopez AL, Cheung ML, Fassett MJ. Diagnosis of disseminated coccidioidomycosis in pregnancy through placental pathology: A case report. Case Rep Womens Health 2022; 34:e00399. [PMID: 35242598 PMCID: PMC8881680 DOI: 10.1016/j.crwh.2022.e00399] [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: 01/23/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/15/2022] Open
Abstract
There are more than 150,000 new cases of coccidioidomycosis annually in the United States and the incidence is increasing. Although the majority of cases result in mild or no symptoms, pregnancy is a risk factor for complicated and disseminated disease. Overall, coccidioidomycosis is rare in pregnancy and there have been few reports in the literature of dissemination into the placenta. This report describes a 31-year-old primigravida with coccidioidomycosis diagnosed by placental examination. In retrospect, she had mild symptoms in the antepartum period but otherwise had no immediate complications due to the infection apart from the adhesive pelvic disease. The clinician should have a high index of suspicion for coccidioidomycosis in a pregnant woman presenting with a persistent respiratory illness who resides in, or who has recently recent travelled to, an endemic area. Additionally, a diagnosis of disseminated coccidioidomycosis should be considered for a woman with adhesive pelvic disease residing in an endemic region and one should consider microscopic placental examination if these findings are noted at cesarean delivery. Consider disseminated coccidioidomycosis when adhesive pelvic disease is found in a woman living in an endemic region. Consider coccidioidomycosis in women with respiratory symptoms living in or with recent travel to an endemic region. Pathological examination of the placenta may be helpful in cases of known coccidioidomycosis in pregnancy.
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Affiliation(s)
- Adrian L. Hernandez Lopez
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Los Angeles Medical Center, 4900 Sunset Blvd 5 Floor, Los Angeles, CA 90027, USA
| | - Mon-Lai Cheung
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Discovery Plaza Medical Offices, 1200 Discovery Drive, Bakersfield, CA 90027, USA
| | - Michael J. Fassett
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Kaiser Permanente Southern California, West Los Angeles Medical Center and Discovery Plaza Medical Offices, 6041 Cadillac Ave 3rd Floor, Los Angeles, CA 90034, USA
- Corresponding author.
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9
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Abstract
BACKGROUND Coccidioidomycosis is common in adult and pediatric populations living in endemic areas of the United States but has rarely been reported in neonates. We reviewed recent cases of neonatal coccidioidomycosis treated at a tertiary care children's hospital in an endemic area and compared them with previously reported cases in the literature. METHODS We performed a retrospective chart review of infants 1 month old or less hospitalized with a diagnosis of coccidioidomycosis from January 1, 2014, to December 31, 2019. Additionally, we performed a literature review of all reported cases of neonatal coccidioidomycosis over the past 7 decades through PubMed. Infants born to mothers with confirmed or suspected active coccidioidomycosis were excluded. RESULTS Three cases of neonatal coccidioidomycosis were identified at our institution. Each presented in a unique manner and had an alternative diagnosis at the time of initial presentation. Two patients had negative coccidioidal screening tests upon admission but later seroconverted. All patients had extrapulmonary involvement, and all recovered after appropriate treatment. A review of the literature reveals that the presentations and outcomes of neonatal coccidioidomycosis vary widely. CONCLUSIONS There is significant variability in the presentation of coccidioidomycosis in the neonatal period, and diagnosis may be challenging. In endemic regions, healthcare providers should consider coccidioidomycosis in their differential diagnoses of ill-appearing neonates that do not respond to treatment.
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10
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Gonzalez R, Naeem F, Ozaki Y, Vijayan V. Disseminated Coccidioidomycosis in an Adolescent With Crohn's Disease. Cureus 2021; 13:e19980. [PMID: 34984138 PMCID: PMC8714043 DOI: 10.7759/cureus.19980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 12/02/2022] Open
Abstract
Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis/posadasii. This dimorphic fungus is endemic to the Southwestern United States, particularly in California and Arizona. Most infections are asymptomatic or mild, but around 5% of patients develop complicated pulmonary infection, and approximately 1% may progress to disseminated disease. We present the case of an adolescent male with Crohn's disease who received the integrin inhibitor, vedolizumab, and developed disseminated coccidioidomycosis. This case underscores the importance of considering severe and/or disseminated coccidioidomycosis in immunosuppressed children. In our case, clinical suspicion and bronchoscopy helped confirm the diagnosis and facilitate appropriate evaluation and treatment.
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Affiliation(s)
| | - Fouzia Naeem
- Pediatric Infectious Diseases, Valley Children's Healthcare, Madera, USA
| | | | - Vini Vijayan
- Pediatrics, Valley Children's Healthcare, Madera, USA
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11
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Naeem F, Vijayan V, Kim BY, Rahmati E, McCarty J. Congenital Coccidioidomycosis: A Case Report and Review of the Literature. J Pediatric Infect Dis Soc 2021; 10:789-792. [PMID: 33969875 DOI: 10.1093/jpids/piab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022]
Abstract
Coccidioidomycosis in neonates is rare and the acquisition of disease in this age group is not well understood. Congenital coccidioidomycosis is very rare, usually associated with coccidioidal placentitis. Only a handful of cases of congenital coccidioidomycosis have been described in the literature. We describe an infant with congenital coccidioidomycosis delivered by cesarean section to a mother who was diagnosed with disseminated disease in the second trimester and summarize the available literature on congenital coccidioidomycosis.
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Affiliation(s)
- Fouzia Naeem
- Department of Pediatrics, Valley Children's Healthcare, Madera, California, USA.,Division of Infectious Diseases, Valley Children's Healthcare, Madera, California, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Vini Vijayan
- Department of Pediatrics, Valley Children's Healthcare, Madera, California, USA.,Division of Infectious Diseases, Valley Children's Healthcare, Madera, California, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Bonnie Y Kim
- Department of Pediatrics, University of California San Francisco, Fresno, California, USA
| | - Elham Rahmati
- Department of Internal Medicine, University of California San Francisco, Fresno, California, USA.,Division of Infectious Diseases, University of California San Francisco, Fresno, California, USA
| | - James McCarty
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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12
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Sass G, Larwood DJ, Martinez M, Shrestha P, Stevens DA. Efficacy of nikkomycin Z in murine CNS coccidioidomycosis: modelling sustained-release dosing. J Antimicrob Chemother 2021; 76:2629-2635. [PMID: 34269392 DOI: 10.1093/jac/dkab223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Meningitis is the most feared coccidioidomycosis complication. Nikkomycin Z (nikZ) is a chitin synthase inhibitor. A concern is short half-life, necessitating multiple dose/day regimens. We simulated extended release, providing nikZ in drinking water. Extended release would enhance convenience, and adherence, for patients. METHODS Coccidioides posadasii was injected intracerebrally into mice. Twelve day treatments began on Day 3. Fluconazole was given 100 mg/kg once daily (gavage); designed doses of nikZ 30, 100 or 300 mg/kg/day in drinking water. On Day 30 post-treatment, survivors were euthanized, brain cfu quantitated and cfu in other organs assessed. RESULTS nikZ was stable in drinking water. Survival was 11%, 50%, 70%, 90% and 100% in untreated controls, fluconazole and nikZ 30, 100 and 300 mg/kg/day, respectively ; nikZ 300 mg/kg/day was superior (P ≤ 0.01) to fluconazole. Brains were sterilized in 0%, 20%, 86%, 89% and 80% of mice, respectively; nikZ 100 or 300 mg/kg/day was superior (P ≤ 0.01) to fluconazole. Clearance of infection in other organs was similar. All decreased drinking after infection, causing nikZ mice to ingest less than the desired dose in early therapy; despite this, they recovered sufficiently to resume pre-infection drinking and designed drug intakes. Thus, when sickest, even less than the designed dose was sufficient to enable recovery. CONCLUSIONS This efficacy supports the development of sustained-release nikZ. Decreased intake wouldn't be a factor in humans, receiving drug via extended-release pill or continuous IV infusion. In prior studies (twice daily nikZ) of murine coccidioidal meningitis, results were inferior, suggesting sustained release may provide both convenience and superior outcomes.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA, USA
| | - David J Larwood
- California Institute for Medical Research, San Jose, CA, USA.,Valley Fever Solutions, Tucson, AZ, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, CA, USA
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
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13
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Huang J, Cano EJ, Shweta F, Shah AS, Schuetz AN, Bois M, Gurram PR. Infected Aneurysm of the Native Aorta due to Coccidioides posadasii. Open Forum Infect Dis 2021; 8:ofab266. [PMID: 34159219 PMCID: PMC8214011 DOI: 10.1093/ofid/ofab266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/20/2021] [Indexed: 11/12/2022] Open
Abstract
Coccidioidomycosis is an endemic fungal infection that is typically asymptomatic or associated with pulmonary disease. Extrapulmonary disease may involve the skin, bones, or central nervous system, yet endovascular infections are exceedingly rare. We report the first case, to our knowledge, of coccidioidomycosis of the native aorta in an immunocompromised host.
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Affiliation(s)
- Jeffrey Huang
- Division of Critical Care, Mayo Clinic, Rochester, Minnesota, USA.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edison J Cano
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Infectious Diseases Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Fnu Shweta
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya S Shah
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pooja R Gurram
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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14
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Trainor M, Henkel E, Diaz LZ, Carrasco R. Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab. Pediatr Rheumatol Online J 2021; 19:63. [PMID: 33933122 PMCID: PMC8088673 DOI: 10.1186/s12969-021-00549-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coccidioides immitis is a dimorphic fungus endemic to the arid climates of the Southwest United States, Mexico and parts of Central and South America. Human infection occurs through inhalation of spores with less than half of exposures progressing to a symptomatic state that primarily consists of pulmonary manifestations. Disseminated coccidioidomycosis is exceedingly rare, occurring in fewer than 1 % of symptomatic infections. Through hematogenous spread, the fungus can infect most organ systems and may be fatal without systemic antifungal treatment. Individuals with impaired cell-mediated immunity either from primary immunodeficiency disorders or secondary to immunosuppression with medications such as tumor necrosis factor alpha (TNF-α) inhibitors have increased risk of disseminated coccidioidomycosis and previous cases of coccidioidomycosis have been reported with biologic therapy. CASE PRESENTATION We present a case of disseminated coccidioidomycosis in a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) being treated with prednisone, methotrexate, and infliximab. The patient presented with symptoms of meningeal irritation, bilateral choroidal lesions, and necrotizing peripheral pneumonia. Her infection was thought to be a reactivation of coccidioidomycosis given her history of resolved pneumonia that occurred after traveling to Arizona, New Mexico, and El Paso one year prior to presentation. Following diagnosis, she improved with discontinuation of her immunosuppressive medications and two weeks of intravenous amphotericin B and fluconazole with plans for lifetime treatment with fluconazole while immunosuppressed. Due to worsening arthritis, she will begin tofacitinib and continue close monitoring of chest x-rays and coccidioides antibody. CONCLUSIONS Patients undergoing immunosuppressive therapy for rheumatological conditions are at increased risk of disseminated coccidioidomycosis and should be evaluated with high suspicion when presenting with atypical symptoms and history of travel to endemic regions.
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Affiliation(s)
- Megan Trainor
- Division of Dermatology, Dell Medical School, University of Texas at Austin, 601 E 15th St, CEC C2.470 , Austin, TX, 78701 , USA.
| | - Emily Henkel
- grid.267309.90000 0001 0629 5880Long School of Medicine, University of Texas Health Science Center at San Antonio, Texas San Antonio, USA
| | - Lucia Z. Diaz
- grid.89336.370000 0004 1936 9924Division of Dermatology, Dell Medical School, University of Texas at Austin, 601 E 15th St, CEC C2.470 , Austin, TX 78701 USA ,grid.413578.c0000 0004 0637 322XDell Children’s Medical Center, Texas Austin, USA ,grid.89336.370000 0004 1936 9924Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas USA
| | - Ruy Carrasco
- grid.487005.e0000 0004 0368 0216Presbyterian Healthcare Services, New Mexico Albuquerque, USA
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15
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Panicker RR, Bartels HC, Gotway MB, Ampel NM, Buras MR, Lim ES, Blair JE. Cavitary Coccidioidomycosis: Impact of azole antifungal therapy. Med Mycol 2021; 59:834-841. [PMID: 33724424 DOI: 10.1093/mmy/myab011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Approximately 5 to 15% of patients with pulmonary coccidioidomycosis subsequently develop pulmonary cavities. These cavities may resolve spontaneously over a number of years; however, some cavities never close, and a small proportion causes complications such as hemorrhage, pneumothorax or empyema. The impact of azole antifungal treatment on coccidioidal cavities has not been studied. Because azoles are a common treatment for symptomatic pulmonary coccidioidomycosis, we aimed to assess the impact of azole therapy on cavity closure. From January 1, 2004, through December 31, 2014, we retrospectively identified 313 patients with cavitary coccidioidomycosis and excluded 42 who had the cavity removed surgically, leaving 271 data sets available for study. Of the 271 patients, 221 (81.5%) received azole therapy during 5-year follow-up; 50 patients did not receive antifungal treatment. Among the 271 patients, cavities closed in 38 (14.0%). Statistical modeling showed that cavities were more likely to close in patients in the treated group than in the nontreated group (hazard ratio, 2.14 [95% CI: 1.45-5.66]). Cavities were less likely to close in active smokers than nonsmokers (11/41 [26.8%] vs 97/182 [53.3%]; P = 0.002) or in persons with than without diabetes (27/74 [36.5%] vs 81/149 [54.4%]; P = 0.01).We did not find an association between cavity size and closure. Our findings provide rationale for further study of treatment protocols in this subset of patients with coccidioidomycosis. LAY SUMMARY Coccidioidomycosis, known as valley fever, is a fungal infection that infrequently causes cavities to form in the lungs, which potentially results in long-term lung symptoms. We learned that cavities closed more often in persons who received antifungal drugs, but most cavities never closed completely.
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Affiliation(s)
- Renni R Panicker
- Research Trainee (limited tenure), Mayo Clinic, Scottsdale, Arizona, USA, now with the Department of Internal Medicine, Louisiana State University Health Science Center, Lafayette, Louisiana, 70504, USA
| | - Helen C Bartels
- Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, 85259, USA
| | - Michael B Gotway
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA
| | - Neil M Ampel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA
| | | | | | - Janis E Blair
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, 85054, USA
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16
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Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
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Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
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17
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Shah R, Shanina E, Smith RG, Bhardwaj A. A Rare Case of Disseminated Coccidioidomycosis Presenting as Brachial Plexopathy. Cureus 2020; 12:e11370. [PMID: 33178544 PMCID: PMC7652370 DOI: 10.7759/cureus.11370] [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] [Indexed: 12/03/2022] Open
Abstract
Coccidioidomycosis, a fungal infection caused by inhaling spores of Coccidioides immitis/posadasii, is endemic to the southwestern states of the United States, Northern Mexico and some parts of Central and South America. It is primarily a pulmonary infection with less than 0.5% of symptomatic cases showing dissemination. Skin, lymph nodes and bone are the commonest sites. Neurological involvement is rare and commonly presents as strokes, abscesses or meningoencephalitis. We present the case of a previously healthy 23-year-old African American male, presented with a four-month history of progressive right upper extremity weakness that initially started with right shoulder pain followed by worsening weakness and loss of muscle mass. Electromyography (EMG) demonstrated right brachial plexopathy with moderate-to-severe active denervation changes. MRI cervical spine revealed a 9-cm contrast enhancing extradural mass extending through the neural foramen from C4-T1 roots and forming a 4-cm right apical lung mass subsequently seen on MRI of the brachial plexus. All trunks, divisions and cords were thickened, hyperintense and showed contrast enhancement on MRI. Neuromuscular ultrasound (NUS) demonstrated enlargement of peripheral nerves. Differentials prior to biopsy of the mass ranged from neurofibromas to pancoast lung tumors. Coccidioidomycosis did not figure on the initial list of differentials. Patient underwent subsequent biopsy of the extradural and lung masses that showed coccidiodes. Serum coccidioides antibody titers were elevated. The patient was treated with high-dose intravenous fluconazole and aggressive mass debridement. His weakness improved on four months follow-up evaluation with significant resolution of EMG abnormalities and decreased swelling on NUS.
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Affiliation(s)
- Rahul Shah
- Neurology/Neurocritical Care, Bakersfield Memorial Hospital, Bakersfield, USA
| | - Elena Shanina
- Neurology, University of Texas Medical Branch, Galveston, USA
| | | | - Anish Bhardwaj
- Neurology, University of Texas Medical Branch, Galveston, USA
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18
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Larwood DJ. Nikkomycin Z-Ready to Meet the Promise? J Fungi (Basel) 2020; 6:E261. [PMID: 33143248 PMCID: PMC7712250 DOI: 10.3390/jof6040261] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Nikkomycin Z (NikZ) has fungicidal activity against some fungal species which currently requires patients to endure chronic therapy, sometimes for years. This review highlights reports of NikZ activity against fungal species for which current therapeutics are still inadequate, as a potential roadmap for continuing investigation. The possibility of faster and more complete clinical resolution by using NikZ has attracted scientific attention for decades. NikZ inhibits chitin structure formation, which is important for fungi, but not found in mammals. NikZ raised no safety concerns in a human Phase 1 trial or in extensive toxicology studies. NikZ showed strong clinical benefit in dogs with natural Coccidioides infection. NikZ has protected animals against fatal infections of Candida albicans. NikZ provides high protection in synergistic combination with several agent classes against Candida and Aspergillus species.
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Affiliation(s)
- David J. Larwood
- Valley Fever Solutions, Tucson, AZ 85719, USA; ; Tel.: +1-650-454-4126
- College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- California Institute of Medical Research, San Jose, CA 95128, USA
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19
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Stevens DA, Martinez M, Sass G, Pappagianis D, Doherty B, Kutsche H, McGuire M. Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis. J Fungi (Basel) 2020; 6:jof6030125. [PMID: 32759879 PMCID: PMC7558155 DOI: 10.3390/jof6030125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Meningitis is the most devastating form of coccidioidomycosis. A convenient, rapid diagnostic method could result in early treatment and avoid many meningitis complications. We studied cerebrospinal fluid (CSF) samples in patients with documented coccidioidal meningitis, and controls, with complement fixation (CF), immunodiffusion (ID) (the “classical” assays), lateral flow assays (LFA; one-strip and two-strip), and two enzyme immunoassays (EIA). The two-strip LFA and EIAs not only enabled separate testing for IgG and IgM antibodies separately, but also could aggregate results for each method. CF with ID or the aggregate use of IgG and IgM tests were considered optimal test uses. LFAs and EIAs were evaluated at 1:21 and 1:441 dilutions of specimens. All assays were compared to true patient status. With 49 patient specimens and 40 controls, this is the largest comparative study of CSF coccidioidal diagnostics. Sensitivity of these tests ranged from 71–95% and specificity 90–100%. IgM assays were less sensitive. Assays at 1:441 were similarly specific but less sensitive, suggesting that serial dilutions of samples could result in assays yielding titers. Agreement of positive results on cases was 87–100%. When kits are available, hospital laboratories in endemic areas can perform testing. LFA assays do not require a laboratory, are simple to use, and give rapid results, potentially even at the bedside.
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Affiliation(s)
- David A. Stevens
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
| | - Marife Martinez
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
| | - Gabriele Sass
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
| | - Demosthenes Pappagianis
- Department of Medical Microbiology, University of California School of Medicine, Davis, CA 95616, USA;
| | - Brian Doherty
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
| | - Hannah Kutsche
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
| | - Meredith McGuire
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
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20
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Extrapulmonary Coccidioidomycosis Among Children in Central California: A Retrospective Review. Pediatr Infect Dis J 2019; 38:1189-1194. [PMID: 31738333 DOI: 10.1097/inf.0000000000002470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The literature on pediatric extrapulmonary coccidioidomycosis is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis followed at a tertiary care center in central California. METHODS Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis diagnosed over 10 years (1/1/07-12/31/16). RESULTS The median age was 9.7 years (interquartile range, 4.5-14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P = 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P = 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P = 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P = 0.04) and tended to have Coccidioides complement fixation titers ≥1:32 (89% vs. 72%, P = 0.04) compared with Hispanics. CONCLUSIONS Extrapulmonary coccidioidomycosis in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.
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21
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Asbury K, Blair JE, August J, Beatty NL, Mi L, Carey EJ, Huskey JL, LeMond LM, Zangeneh TT. De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant. Am J Transplant 2019; 19:2517-2524. [PMID: 30811848 DOI: 10.1111/ajt.15324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 01/25/2023]
Abstract
Solid organ transplant recipients who contract coccidioidomycosis are at risk for complicated, protracted, disseminated, and severe disease. To date, no studies have described outcomes for patients who develop coccidioidomycosis only after the first posttransplant year. This study was a joint project of Mayo Clinic Hospital, Phoenix, Arizona, and the University of Arizona/Banner University Medical Center, Tucson, Arizona. We retrospectively reviewed electronic health records for patients with a history of solid organ transplant between January 1, 1998, and October 11, 2014, who developed coccidioidomycosis after the first transplant year. We identified 91 patients. Of those, 37/91 (40.7%) had pulmonary coccidioidomycosis (29/37 [78.4%] were symptomatic); and 5/91 (5.5%) had extrapulmonary disease (all were symptomatic). One patient (1.1%) died. Coccidioidomycosis was evident in 2/91 (2.2%) patients within 3 months of antirejection treatment. Many of the patients (51/91 [56.0%]) had asymptomatic coccidioidomycosis, 27 (27.9%) of whom were followed up closely but did not receive antifungal medication and had no sequelae. Although solid organ recipients taking low-level immunosuppression after the first posttransplant year appeared to have less symptomatic, disseminated, or fatal coccidioidal infection than historical cohorts, this remains an important infection with morbidity and mortality even after the first posttransplant year.
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Affiliation(s)
- Kara Asbury
- Private practice, Infectious Diseases, Phoenix, Arizona
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | - Jessica August
- Division of Infectious Diseases, Banner University Medical Center, University of Arizona, Tucson, Arizona
| | - Norman L Beatty
- Division of Infectious Diseases, Banner University Medical Center, University of Arizona, Tucson, Arizona
| | - Lanyu Mi
- Department of Biomedical Statistics and Informatics and Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Elizabeth J Carey
- Division of Gastroenterology, Mayo Clinic Hospital, Phoenix, Arizona.,Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona
| | - Janna L Huskey
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona.,Division of Nephrology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Lisa M LeMond
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona.,Department of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | - Tirdad T Zangeneh
- Division of Infectious Diseases, Banner University Medical Center, University of Arizona, Tucson, Arizona
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22
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Davidson AP, Shubitz LF, Alcott CJ, Sykes JE. Selected Clinical Features of Coccidioidomycosis in Dogs. Med Mycol 2019; 57:S67-S75. [PMID: 30690600 DOI: 10.1093/mmy/myy113] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
Canine coccidioidomycosis, a systemic fungal infection endemic to arid and semiarid regions of North, Central, and South America, is commonly diagnosed in dogs living in or traveling through lower Sonoran life zones in the states of California and Arizona. Canine and human cases have geographic overlap. Similarities between clinical coccidioidomycosis in dogs and humans include asymptomatic infection, primary respiratory disease and disseminated disease. Differences include a high rate of dissemination in dogs, differences in predilection of dissemination sites, and a granulomatous or diffuse meningoencephalopathic form in the canine central nervous system (CNS) without the obstructive component seen in humans. Dogs presenting with CNS coccidioidomycosis most commonly experience seizures. Prior disease history and serology are unreliable indicators of CNS coccidioidomycosis. Magnetic resonance imaging (MRI) is advantageous for diagnosis of CNS coccidioidomycosis in dogs. Long-term administration of antifungal medication is promoted for treatment of both primary and disseminated coccidioidomycosis in dogs. Supportive treatment addressing pain, fever, inappetance, coughing, and other clinical signs improves patient care. Glucocorticoids and or anticonvulsants are also recommended for canine disseminated CNS disease. Protracted treatment times, lack of owner compliance, failure of the disease to respond to the first antifungal drug selected, and high cost are challenges of successfully treating dogs.
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Affiliation(s)
- Autumn P Davidson
- School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Lisa F Shubitz
- Valley Fever Center for Excellence, The University of Arizona, Tucson, Arizona, USA
| | - Cody J Alcott
- Veterinary Specialty Center of Tucson, Tucson, Arizona, USA
| | - Jane E Sykes
- School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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23
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The Rise of Valley Fever: Prevalence and Cost Burden of Coccidioidomycosis Infection in California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071113. [PMID: 30925716 PMCID: PMC6480346 DOI: 10.3390/ijerph16071113] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 11/23/2022]
Abstract
Coccidioidomycosis (CM) is a fungal infection endemic in the southwestern United States (US). In California, CM incidence increased more than 213% (from 6.0/100,000 (2014) to 18.8/100,000 (2017)) and continues to increase as rates in the first half of 2018 are double that of 2017 during the same period. This cost-of-illness study provides essential information to be used in health planning and funding as CM infections continue to surge. We used a “bottom-up” approach to determine lifetime costs of 2017 reported incident CM cases in California. We defined CM natural history and used a societal approach to determine direct and discounted indirect costs using literature, national datasets, and expert interviews. The total lifetime cost burden of CM cases reported in 2017 in California is just under $700 million US dollars, with $429 million in direct costs and $271 million in indirect costs. Per person direct costs were highest for disseminated disease ($1,023,730), while per person direct costs were lowest for uncomplicated CM pneumonia ($22,039). Cost burden varied by county. This is the first study to estimate total costs of CM, demonstrating its huge cost burden for California.
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24
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Pediatric Coccidioidomycosis: Case Series From a California Pediatric Infectious Diseases Clinic. Pediatr Infect Dis J 2019; 38:115-121. [PMID: 29620721 DOI: 10.1097/inf.0000000000002069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coccidioidomycosis is not as well described in the pediatric population as it is in the adult population. We describe clinical findings, diagnosis and management of coccidioidomycosis in 108 pediatric patients seen in an outpatient clinic in the California Central Valley, an area endemic for coccidioidomycosis. METHODS We reviewed medical records of a convenience sample of pediatric patients (≤17 years of age) diagnosed with coccidioidomycosis who visited an infectious diseases clinic in Madera, CA, during January 1 to October 1, 2012. We described demographic characteristics, symptoms, diagnostic testing, extent of infection (acute/pulmonary or disseminated), treatment and management. RESULTS Of 108 patients, 90 (83%) had acute/pulmonary coccidioidomycosis and 18 (17%) had disseminated disease. The median age at diagnosis was 9 years (range, 5 months to 17 years). Only 3 (3%) patients were immunocompromised. Before coccidioidomycosis diagnosis, 72 (82%) patients received antibiotics, and 31 (29%) had at least 1 negative coccidioidomycosis serology at the time of or before diagnosis. Coccidioidomycosis was diagnosed significantly later after symptom onset among patients with disseminated (median, 57 days) than with acute/pulmonary (median, 16 days) disease (p < 0.01). A total of 104 (96%) patients received antifungal therapy, 51 (47%) visited an emergency room and 59 (55%) were hospitalized with a median stay of 44 days (range, 1-272 days). CONCLUSIONS Substantial acute/pulmonary and disseminated coccidioidomycosis was seen among pediatric patients at this infectious disease clinic in California. In endemic areas, increased coccidioidomycosis awareness and vigilance among families and providers is necessary to facilitate early diagnosis and appropriate management.
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25
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Fox T, Solomon R, Kaka A. Disseminated coccidioidomycosis. Postgrad Med J 2018; 94:722-723. [PMID: 29970388 DOI: 10.1136/postgradmedj-2017-135545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Teresa Fox
- Department of Infectious Diseases, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robin Solomon
- Department of Pathology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anjum Kaka
- Department of Infectious Diseases, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, Minnesota, USA
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26
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Evaluation of Amphotericin B Lipid Formulations for Treatment of Severe Coccidioidomycosis. Antimicrob Agents Chemother 2018; 62:AAC.02293-17. [PMID: 29686150 DOI: 10.1128/aac.02293-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/07/2018] [Indexed: 11/20/2022] Open
Abstract
Patients with severe coccidioidomycosis infections are often treated with either amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L-AmB). Outcome data with these agents in severe coccidioidomycosis cases are currently lacking. The purpose of this study is to evaluate the efficacy and toxicity of ABLC and L-AmB in treating severe coccidioidomycosis. A retrospective pre-post study design was employed. Chart reviews were completed from 1 January 2005 to 31 December 2014 for all patients who received lipid-based amphotericin B. Inclusion criteria included having a follow-up complement fixation (CF) titer or a treatment emergent adverse event (TEAE) prior to follow-up. Patients with meningeal involvement and pregnant patients were excluded. Treatment outcomes were assessed based on documented completion of therapy as well on symptoms, complement fixation titer, and changes to laboratory monitoring parameters. A total of 108 patients were identified, 69 of whom met the inclusion criteria. There were no statistical differences in demographics or disease burden in those that received ABLC and those that received L-AmB, except that those who received L-AmB were more likely to have previously diagnosed chronic kidney disease (nL-AmB = 4, 12.5% vs nABLC = 0, 0.0%; P = 0.042) and to have a lower creatinine clearance at the start of therapy (L-AmB = 79.6 mg/dl versus ABLC = 100.4 mg/dl; P = 0.008). Successful treatment was achieved in 27 (73.0%) of ABLC patients and 22 (68.8%) of L-AmB patients (P = 0.700). Amphotericin B was discontinued due to documented completion of therapy for 17 (45.9%) ABLC patients and 18 (56.3%) L-AmB patients (P = 0.553). Acute kidney injury (AKI) was the documented reason of treatment cessation for 10 (27.0%) ABLC and 1 (3.1%) L-AmB patient (P = 0.007). ABLC and L-AmB both appear to be equally efficacious in the treatment of severe coccidioidomycosis. L-AmB may have less renal toxicity than ABLC and may be the preferred agent in baseline renal impairment.
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Abstract
Filamentous and dimorphic fungi cause invasive mycoses associated with high mortality rates. Among the fungal determinants involved in the establishment of infection, glycosphingolipids (GSLs) have gained increased interest in the last few decades. GSLs are ubiquitous membrane components that have been isolated from both filamentous and dimorphic species and play a crucial role in polarized growth as well as hypha-to-yeast transition. In fungi, two major classes of GSLs are found: neutral and acidic GSLs. Neutral GSLs comprise glucosylceramide and galactosylceramide, which utilize Δ4-Δ8-9-methyl-sphingadienine as a sphingoid base, linked to a C16-18 fatty acid chain, forming ceramide, and to a sugar residue, such as glucose or galactose. In contrast, acidic GSLs include glycosylinositol phosphorylceramides (GIPCs), composed of phytosphingosine attached to a long or very long fatty acid chain (C18-26) and to diverse and complex glycan groups via an inositol-phosphate linker. GIPCs are absent in mammalian cells, while fungal glucosylceramide and galactosylceramide are present but diverge structurally from their counterparts. Therefore, these compounds and their biosynthetic pathways represent potential targets for the development of selective therapeutic strategies. In this minireview, we discuss the enzymatic steps involved in the production of fungal GSLs, analyze their structure, and address the role of the currently characterized genes in the biology and pathogenesis of filamentous and dimorphic fungi.
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28
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Why is this patient's chronic knee pain worsening? JAAPA 2018; 31:50-52. [PMID: 29698371 DOI: 10.1097/01.jaa.0000531048.51513.bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Charalambous LT, Premji A, Tybout C, Hunt A, Cutshaw D, Elsamadicy AA, Yang S, Xie J, Giamberardino C, Pagadala P, Perfect JR, Lad SP. Prevalence, healthcare resource utilization and overall burden of fungal meningitis in the United States. J Med Microbiol 2018; 67:215-227. [PMID: 29244019 PMCID: PMC6557145 DOI: 10.1099/jmm.0.000656] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Previous epidemiological and cost studies of fungal meningitis have largely focused on single pathogens, leading to a poor understanding of the disease in general. We studied the largest and most diverse group of fungal meningitis patients to date, over the longest follow-up period, to examine the broad impact on resource utilization within the United States. METHODOLOGY The Truven Health Analytics MarketScan database was used to identify patients with a fungal meningitis diagnosis in the United States between 2000 and 2012. Patients with a primary diagnosis of cryptococcal, Coccidioides, Histoplasma, or Candida meningitis were included in the analysis. Data concerning healthcare resource utilization, prevalence and length of stay were collected for up to 5 years following the original diagnosis. RESULTS Cryptococcal meningitis was the most prevalent type of fungal meningitis (70.1 % of cases over the duration of the study), followed by coccidioidomycosis (16.4 %), histoplasmosis (6.0 %) and candidiasis (7.6 %). Cryptococcal meningitis and candidiasis patients accrued the largest average charges ($103 236 and $103 803, respectively) and spent the most time in the hospital on average (70.6 and 79 days). Coccidioidomycosis and histoplasmosis patients also accrued substantial charges and time in the hospital ($82 439, 48.1 days; $78 609, 49.8 days, respectively). CONCLUSION Our study characterizes the largest longitudinal cohort of fungal meningitis in the United States. Importantly, the health economic impact and long-term morbidity from these infections are quantified and reviewed. The healthcare resource utilization of fungal meningitis patients in the United States is substantial.
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Affiliation(s)
| | - Alykhan Premji
- Department of Neurosurgery, Duke University Medical Center, NC, USA
| | - Caroline Tybout
- Department of Neurosurgery, Duke University Medical Center, NC, USA
| | - Anastasia Hunt
- Department of Neurosurgery, Duke University Medical Center, NC, USA
| | - Drew Cutshaw
- Department of Neurosurgery, Duke University Medical Center, NC, USA
| | | | - Siyun Yang
- Department of Biostatistics, Duke University, NC, USA
| | - Jichun Xie
- Department of Biostatistics, Duke University, NC, USA
| | | | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, NC, USA
| | - John R. Perfect
- Division of Infectious Diseases, Duke University Medical Center, NC, USA
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University Medical Center, NC, USA
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Teixeira MM, Barker BM. Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides. Emerg Infect Dis 2018; 22:1022-30. [PMID: 27191589 PMCID: PMC4880095 DOI: 10.3201/eid2206.151565] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although Coccidioides genotypes are highly genetically variable,
they cluster into discrete populations, which has implications for human
infections. During the past 20 years, a general picture of the genetic diversity and population
structure of Coccidioides, the causal agent of coccidioidomycosis
(Valley fever), has emerged. The genus consists of 2 genetically diverse species,
C. immitis and C. posadasii, each of which
contains 1 or more distinct populations with limited gene flow. Genotypic data
indicate that C. immitis is divided into 2 subpopulations (central
and southern California populations) and C. posadasii is divided
into 3 subpopulations (Arizona, Mexico, and Texas/South America populations).
However, admixture within and among these populations and the current paucity of
environmental isolates limit our understanding of the population genetics of
Coccidioides. We assessed population structure of
Coccidioides in Arizona by analyzing 495 clinical and
environmental isolates. Our findings confirm the population structure as previously
described and indicate a finer scale population structure in Arizona. Environmental
isolates appear to have higher genetic diversity than isolates from human
patients.
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31
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Lee LA, Yuan J, Vugia D, Wheeler C, Chapnick R, Mohle-Boetani J. Increased Coccidioidomycosis Among Inmates at a California Prison: Initial Investigation in 2005 to 2006. JOURNAL OF CORRECTIONAL HEALTH CARE 2017; 23:347-352. [PMID: 28656821 DOI: 10.1177/1078345817716451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 2005, coccidioidomycosis has increased among inmates at a California prison. Our initial investigation found an incidence of 3,323 cases/100,000 persons. Black race, age ≥41 years, and residence on Yard C were significantly associated with coccidioidomycosis ( p < .05). Inmates at this prison have continued to be at risk for coccidioidomycosis.
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Affiliation(s)
- Lauren A Lee
- 1 California Department of Public Health, Richmond, CA, USA
| | - Jean Yuan
- 1 California Department of Public Health, Richmond, CA, USA.,2 Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Duc Vugia
- 1 California Department of Public Health, Richmond, CA, USA
| | - Charlotte Wheeler
- 1 California Department of Public Health, Richmond, CA, USA.,3 California Correctional Health Care Services, Elk Grove, CA, USA
| | - Robert Chapnick
- 3 California Correctional Health Care Services, Elk Grove, CA, USA
| | - Janet Mohle-Boetani
- 1 California Department of Public Health, Richmond, CA, USA.,3 California Correctional Health Care Services, Elk Grove, CA, USA
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32
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Sondermeyer GL, Lee LA, Gilliss D, Vugia DJ. Coccidioidomycosis-Associated Deaths in California, 2000-2013. Public Health Rep 2017; 131:531-5. [PMID: 27453596 DOI: 10.1177/0033354916662210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of cases of coccidioidomycosis and associated hospitalizations increased in California during 2000-2013. During that period, a total of 1,098 death records listed coccidioidomycosis as a cause, averaging 78 deaths annually (range: 43-108). The death rate peaked in 2006 and was significantly higher among males than among females, among African American patients than among white patients, and among residents of the coccidioidomycosis-endemic region of California than among residents of the less endemic regions (p<0.001). A higher death rate was associated with increasing age and was highest (8.8 per 1 million population) among adults aged ≥75 years. Of coccidioidomycosis-associated deaths, 31.9% had a contributing cause of death of severe/disseminated disease, 31.8% of unspecified -coccidioidomycosis, and 28.3% of pulmonary unspecified coccidioidomycosis, per International Classification of Diseases codes. Diabetes was a contributing cause in 19.3% of deaths, and other immunocompromising conditions were a contributing cause in 15.9% of deaths. Populations at higher risk for coccidioidomycosis--associated deaths are similar to those at higher risk for coccidioidomycosis-associated hospitalizations and infection. Awareness for coccidioidomycosis among these groups and their providers is important for proper diagnosis and care.
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Affiliation(s)
- Gail L Sondermeyer
- California Department of Public Health, Infectious Diseases Branch, Richmond, CA
| | - Lauren A Lee
- California Department of Public Health, Infectious Diseases Branch, Richmond, CA
| | - Debra Gilliss
- California Department of Public Health, Infectious Diseases Branch, Richmond, CA
| | - Duc J Vugia
- California Department of Public Health, Infectious Diseases Branch, Richmond, CA
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33
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Sondermeyer Cooksey GL, Wilken JA, McNary J, Gilliss D, Shusterman D, Materna BL, Vugia DJ. Dust Exposure and Coccidioidomycosis Prevention Among Solar Power Farm Construction Workers in California. Am J Public Health 2017. [PMID: 28640687 DOI: 10.2105/ajph.2017.303820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate if work activities, dust exposure, and protection measures were associated with a 2011 to 2014 coccidioidomycosis outbreak among workers constructing 2 solar farms in California. METHODS In 2013, we mailed self-administered questionnaires to employees who were onsite at the solar farms where the outbreak occurred to identify cases of clinical coccidioidomycosis and compare with asymptomatic workers by using multivariate logistic regression. RESULTS When we compared 89 workers with clinical coccidioidomycosis to 325 asymptomatic workers, frequently being in a dust cloud or storm (odds ratio [OR] = 5.93; 95% confidence interval [CI] = 3.18, 11.06) significantly increased the odds of clinical coccidioidomycosis, whereas frequently wetting soil before soil-disturbing activity (OR = 0.42; 95% CI = 0.24, 0.75) was protective. When we controlled for being in a dust cloud or storm, frequent soil disturbance significantly increased the odds of clinical coccidioidomycosis only among those who reported wearing a respirator infrequently (OR = 2.31; 95% CI = 1.27, 4.21). CONCLUSIONS Utilization of personal and employer-driven safety practices and increased coccidioidomycosis awareness among construction workers should be considered during the planning of any construction work in coccidioidomycosis-endemic regions to prevent occupational infections and outbreaks.
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Affiliation(s)
- Gail L Sondermeyer Cooksey
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jason A Wilken
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer McNary
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Debra Gilliss
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dennis Shusterman
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara L Materna
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Duc J Vugia
- All of the authors are with California Department of Public Health, Richmond. Jason A. Wilken is also with the Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA
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34
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Malik U, Cheema H, Kandikatla R, Ahmed Y, Chakrala K. Disseminated Coccidioidomycosis Presenting as Carcinomatosis Peritonei and Intestinal Coccidioidomycosis in a Patient with HIV. Case Rep Gastroenterol 2017; 11:114-119. [PMID: 28611563 PMCID: PMC5465799 DOI: 10.1159/000456655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/16/2017] [Indexed: 11/19/2022] Open
Abstract
Coccidioidomycosis (CM) is a fungal infection endemic in southwestern regions of the United States, northwestern regions of Mexico, and some areas of Brazil and Argentina. Clinical presentation varies depending on the extent of the infection and the immune status of the host. The most common presentation ranges from flu-like symptoms to self-limiting pneumonia. Extrapulmonary presentations are uncommon and may involve the meninges, skin, and bone. Gastrointestinal and peritoneal involvement is extremely rare. Here we report a case of disseminated CM presenting as carcinomatosis peritonei as an AIDS-defining illness in a young male.
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Affiliation(s)
- Umer Malik
- Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Hira Cheema
- Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | | | - Yasir Ahmed
- Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Kalyan Chakrala
- Texas Tech University Health Sciences Center, Odessa, Texas, USA
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35
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Infectious Diseases. Dermatology 2017. [DOI: 10.1007/978-3-319-47395-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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36
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Cerebrospinal Fluid (1,3)-Beta-d-Glucan Testing Is Useful in Diagnosis of Coccidioidal Meningitis. J Clin Microbiol 2016; 54:2707-2710. [PMID: 27558179 DOI: 10.1128/jcm.01224-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/16/2016] [Indexed: 11/20/2022] Open
Abstract
Diagnosing coccidioidal meningitis (CM) can be problematic owing to its infrequency and/or a delay in the positivity of a cerebrospinal fluid (CSF) culture or CSF antibody, particularly if the primary coccidioidal infection is unrecognized. We tested 37 CSF specimens, 26 from patients with confirmed CM and 11 from patients with suspected microbial meningitis without fungal diagnosis, for (1,3)-beta-glucan (BG). BG in CM CSF specimens ranged from 18 to 3,300 pg/ml and in controls ranged from <3.9 to 103 pg/ml. Diagnostic performance was determined using a 31-pg/ml cutoff (the bottom of the serum range according to the directions for the commercial kit, although further serial dilutions of the standard indicated linearity to 3.9). Sensitivity was 96%, specificity was 82%, positive and negative predictive values were 93% and 90%, and the area under the receiver operating characteristic curve was 0.937. Fifteen of 15 samples of >103 pg/ml were CM. The one false-negative specimen was from a patient with a pseudosyrinx, without inflammatory evidence of meningitis activity. Serial samples from some patients were positive at ≤8 years, indicating no loss of positivity with chronicity. Samples stored frozen since 2000 included those with 2 of the 3 highest values, indicating that fresh samples not required. A previous study indicated serum sensitivities of 53% in acute, 50% in resolved, and 83% in disseminated and meningeal coccidioidomycosis. Three studies of other fungal meningitides ranged from 86 to 1,524 pg/ml CSF, with 37 controls of <4 to 115 pg/ml CSF. CSF BG analysis had good diagnostic performance in CM. CSF BG testing can be useful in CM, and a commercial kit is available. It will be of interest to correlate this with course, treatment, outcome, inflammation, and antigen. The only mycoses with common central nervous system (CNS) involvement are cryptococcal and coccidioidal, so CSF BG screening can be useful in meningitis diagnosis.
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37
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Davies HD. Infectious Complications With the Use of Biologic Response Modifiers in Infants and Children. Pediatrics 2016; 138:peds.2016-1209. [PMID: 27432853 DOI: 10.1542/peds.2016-1209] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Biologic response modifiers (BRMs) are substances that interact with and modify the host immune system. BRMs that dampen the immune system are used to treat conditions such as juvenile idiopathic arthritis, psoriatic arthritis, or inflammatory bowel disease and often in combination with other immunosuppressive agents, such as methotrexate and corticosteroids. Cytokines that are targeted include tumor necrosis factor α; interleukins (ILs) 6, 12, and 23; and the receptors for IL-1α (IL-1A) and IL-1β (IL-1B) as well as other molecules. Although the risk varies with the class of BRM, patients receiving immune-dampening BRMs generally are at increased risk of infection or reactivation with mycobacterial infections (Mycobacterium tuberculosis and nontuberculous mycobacteria), some viral (herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, hepatitis B) and fungal (histoplasmosis, coccidioidomycosis) infections, as well as other opportunistic infections. The use of BRMs warrants careful determination of infectious risk on the basis of history (including exposure, residence, and travel and immunization history) and selected baseline screening test results. Routine immunizations should be given at least 2 weeks (inactivated or subunit vaccines) or 4 weeks (live vaccines) before initiation of BRMs whenever feasible, and inactivated influenza vaccine should be given annually. Inactivated and subunit vaccines should be given when needed while taking BRMs, but live vaccines should be avoided unless under special circumstances in consultation with an infectious diseases specialist. If the patient develops a febrile or serious respiratory illness during BRM therapy, consideration should be given to stopping the BRM while actively searching for and treating possible infectious causes.
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38
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Hammoudeh ZS, Lettieri S. Management of temporomandibular joint Coccidioidomycosis. Cranio 2016; 34:402-405. [PMID: 27077269 DOI: 10.1080/08869634.2015.1106812] [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: 10/21/2022]
Abstract
PURPOSE The aim of this report was to present the first known case of coccidioidomycosis involving the temporomandibular joint, review the literature regarding dissemination to the mandible, and to provide treatment recommendations for this challenging condition. METHODS Coccidioidomycosis of the mandibular condyle was identified in a 30-year-old Somali male residing in Arizona. Due to the difficulty of surgical access and the anticipated temporomandibular joint morbidity of radical condylar debridement, primary medical management was performed. RESULTS Marked symptomatic improvement was observed after 10 days of IV antifungal therapy. Resolution of the abscess with residual bony destruction was observed on CT scan. Based on the results of this patient and review of the literature, an algorithm is presented to help guide management of coccidioidomycosis dissemination to the mandible. CONCLUSION Prolonged antifungal therapy should be attempted for initial management of a Coccidioides abscess involving the condyle with early surgical intervention reserved for the more easily accessible and less functionally compromising portions of the mandible.
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Affiliation(s)
| | - Salvatore Lettieri
- a Division of Plastic Surgery , Mayo Clinic , Rochester , MN , USA.,b Plastic Surgery , Maricopa Integrated Health System , Phoenix , AZ , USA
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39
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Hung CY, Castro-Lopez N, Cole GT. Card9- and MyD88-Mediated Gamma Interferon and Nitric Oxide Production Is Essential for Resistance to Subcutaneous Coccidioides posadasii Infection. Infect Immun 2016; 84:1166-75. [PMID: 26857574 PMCID: PMC4807486 DOI: 10.1128/iai.01066-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/02/2016] [Indexed: 02/06/2023] Open
Abstract
Coccidioidomycosis is a potentially life-threatening respiratory disease which is endemic to the southwestern United States and arid regions of Central and South America. It is responsible for approximately 150,000 infections annually in the United States alone. Almost every human organ has been reported to harbor parasitic cells of Coccidioides spp. in collective cases of the disseminated form of this mycosis. Current understanding of the mechanisms of protective immunity against lung infection has been largely derived from murine models of pulmonary coccidioidomycosis. However, little is known about the nature of the host response to Coccidioides in extrapulmonary tissue. Primary subcutaneous coccidioidal infection is rare but has been reported to result in disseminated disease. Here, we show that activation of MyD88 and Card9 signal pathways are required for resistance to Coccidioides infection following subcutaneous challenge of C57BL/6 mice, which correlates with earlier findings of the protective response to pulmonary infection. MyD88(-/-) andCard9(-/-) mice recruited reduced numbers of T cells, B cells, and neutrophils to the Coccidioides-infected hypodermis com pared to wild-type mice; however, neutrophils were dispensable for resistance to skin infection. Further studies have shown that gamma interferon (IFN-γ) production and activation of Th1 cells characterize resistance to subcutaneous infection. Furthermore, activation of a phagosomal enzyme, inducible nitric oxide synthase, which is necessary for NO production, is a requisite for fungal clearance in the hypodermis. Collectively, our data demonstrate that MyD88- and Card9-mediated IFN-γ and nitric oxide production is essential for protection against subcutaneous Coccidioides infection.
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Affiliation(s)
- Chiung-Yu Hung
- Department of Biology and South Texas Center for Emerging Infectious Diseases, University of Texas, San Antonio, Texas, USA
| | - Natalia Castro-Lopez
- Department of Biology and South Texas Center for Emerging Infectious Diseases, University of Texas, San Antonio, Texas, USA
| | - Garry T Cole
- Department of Biology and South Texas Center for Emerging Infectious Diseases, University of Texas, San Antonio, Texas, USA
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40
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Garcia Garcia SC, Salas Alanis JC, Flores MG, Gonzalez Gonzalez SE, Vera Cabrera L, Ocampo Candiani J. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol 2016; 90:610-9. [PMID: 26560205 PMCID: PMC4631225 DOI: 10.1590/abd1806-4841.20153805] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 07/29/2014] [Indexed: 11/25/2022] Open
Abstract
Coccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is
considered one of the most virulent primary fungal infections. Coccidioides species
live in arid and semi-arid regions, causing mainly pulmonary infection through
inhalation of arthroconidia although many other organs can be affected. Primary
inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892,
the skin has been identified as an important target of this disease. Knowledge of
cutaneous clinical forms of this infection is important and very useful for
establishing prompt diagnosis and treatment. The purpose of this article is to
provide a review of this infection, emphasizing its cutaneous manifestations,
diagnostic methods and current treatment.
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Affiliation(s)
| | | | - Minerva Gomez Flores
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Lucio Vera Cabrera
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo Candiani
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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41
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Coccidioidomycosis in a State Where It Is Not Known to Be Endemic—Missouri, 2004-2013. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Gaab EM, Naeem F. Pediatric Coccidioidomycosis Patients: Perceptions, Quality of Life and Psychosocial Factors. Healthcare (Basel) 2015; 3:775-95. [PMID: 27417796 PMCID: PMC4939562 DOI: 10.3390/healthcare3030775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/06/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022] Open
Abstract
Research investigating the effects of coccidioidomycosis (valley fever) on children and the psychosocial implications of this disease in general is lacking. This study reviews what is known about pediatric coccidioidomycosis patients. It documents the psychological functioning, quality of life, and illness perceptions of a sample of coccidioidomycosis patient families. Primary caregivers of pediatric patients and patients from a major hospital in the San Joaquin Valley of California were interviewed regarding their perceptions of disease detection, access to care and the patient/family experience.
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Affiliation(s)
- Erin Mary Gaab
- Health Sciences Research Institute, University of California, Merced, CA 95343, USA.
| | - Fouzia Naeem
- Valley Children's Hospital, 9300 Valley Children's Pl, Madera, CA 93636, USA.
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Campbell M, Kusne S, Renfree KJ, Vikram HR, Smilack JD, Seville MT, Orenstein R, Blair JE. Coccidioidal Tenosynovitis of the Hand and Wrist: Report of 9 Cases and Review of the Literature. Clin Infect Dis 2015; 61:1514-20. [PMID: 26240199 DOI: 10.1093/cid/civ642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tenosynovitis is an uncommon manifestation of disseminated infection with Coccidioides fungal species. Most experts treat this infection with combined surgical debridement and antifungal medication. The aim of our study was to examine the outcomes of patients with coccidioidal tenosynovitis of the hand and wrist. METHODS We retrospectively searched for the records of patients with coccidioidal tenosynovitis of the hand and wrist at our institution. between 1987 and 2013. We also conducted a review of the literature from 1950 to 2014 to identify additional cases. RESULTS We identified 9 cases of coccidioidal tenosynovitis of the hand and wrist at our institution, along with 5 other cases found in a review of the literature. The relapse rate was high overall (50%) and was higher after discontinuation of antifungal therapy (71%) in both immunocompromised and immunocompetent patients. Results of serologic testing were not predictive of relapse. CONCLUSIONS A treatment strategy for coccidioidal tenosynovitis should focus on long-term administration of antifungal agents.
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Affiliation(s)
| | | | - Kevin J Renfree
- Department of Orthopedics and Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, Arizona
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44
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Coccidioidomycosis Masquerading as Eosinophilic Ascites. Case Rep Gastrointest Med 2015; 2015:891910. [PMID: 26266062 PMCID: PMC4523687 DOI: 10.1155/2015/891910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/12/2015] [Indexed: 11/17/2022] Open
Abstract
Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as "Valley Fever," is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunocompromised individuals. It can affect the central nervous system, bones, joints, skin, and, very rarely, the abdomen. This is the first case report of a patient with coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA). A 27-year-old male presented with acute abdominal pain and distention from ascites. He had eosinophilia of 11.1% with negative testing for stool studies, HIV, and tuberculosis infection. Ascitic fluid exam was remarkable for low serum-ascites albumin gradient (SAAG), PMN count >250/mm(3), and eosinophils of 62%. Abdominal imaging showed thickened small bowel and endoscopic testing negative for gastric and small bowel biopsies. He was treated empirically for spontaneous bacterial peritonitis, but no definitive diagnosis could be made until coccidioidal serology returned positive. We noted complete resolution of symptoms with oral fluconazole during outpatient follow-up. Disseminated coccidioidomycosis can present in an atypical fashion and may manifest as peritonitis with low SAAG EA. The finding of EA in an endemic area should raise the suspicion of coccidioidal dissemination.
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Abstract
BACKGROUND Coccidioidomycosis is an invasive fungal infection caused by the inhalation of aerosolized spores of Coccidioides spp., which reside in the arid soil of the southwestern United States and northern Mexico. Approximately two thirds of cases are asymptomatic, and the remainder usually present with mild flu-like symptoms. Dissemination of coccidioidomycosis is rare, and can lead to extrapulmonic diseases including meningitis, osteomyelitis, and skin and soft-tissue involvement. The purpose of this study is to report our experience with musculoskeletal coccidioidomycosis in children. METHODS This was a retrospective chart review of patients with musculoskeletal infection with Coccidioides spp. at a tertiary care pediatric hospital from 1997 to 2010, identified by a search of ICD-9 codes and hospital diagnoses. Demographic and clinical data were collected from medical records, including the age of the patient, sex, white blood cell count, immunocompetence, length of stay, location of involvement, and initial treatment. In total, 20 children were identified with musculoskeletal coccidioidomycosis. The mean age was 12.3 years (range, 2 to 17 y) at time of diagnosis. Diagnostic criteria included positive imaging tests (plain film+MRI), serologic positive titers, and/or biopsy with positive cultures. RESULTS The most common presenting symptom was bone pain (100%); only 3 (15%) patients had accompanying signs/symptoms of pulmonary infection. Only 2 (5%) patients had a white blood cell count >15×10/L (5%). Locations of infection included the foot (28%), knee (14%), spine (12%), forearm (10%), lower leg (6%), and other sites (30%). Fluconazole was the most common antifungal agent used (75%). Surgical intervention was required in 10 (50%) patients. CONCLUSIONS This is the first series that has described musculoskeletal coccidioidomycosis exclusively in children. This study suggests that the initial presentation of this disease can be nonspecific and difficult to recognize in children. Clinicians should consider this diagnosis when faced with a musculoskeletal infection in children from the southwestern United States and northern Mexico. LEVEL OF EVIDENCE IV (case series).
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Karp NL, Price ER, Wisner DJ, Chang CB, Hylton NM, Joe BN. Extra-mammary findings on breast MRI: a pictorial review. Clin Imaging 2015; 39:547-52. [PMID: 25772531 DOI: 10.1016/j.clinimag.2015.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/22/2014] [Accepted: 01/22/2015] [Indexed: 01/17/2023]
Abstract
Recent improvements in breast coil performance have made detection of extra-mammary findings increasingly common. Some of these findings have important clinical implications. The radiologist should be aware of the spectrum of extra-mammary pathologies found on breast magnetic resonance imaging (MRI) and be able to distinguish clinically significant findings from those that are inconsequential. The purpose of this essay is to demonstrate various common and uncommon extra-mammary findings encountered while interpreting breast MRI and to detail appropriate management recommendations.
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Affiliation(s)
- Norna L Karp
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Elissa R Price
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115.
| | - Dorota J Wisner
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - C Belinda Chang
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Nola M Hylton
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Bonnie N Joe
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
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Kahn A, Carey EJ, Blair JE. Universal fungal prophylaxis and risk of coccidioidomycosis in liver transplant recipients living in an endemic area. Liver Transpl 2015; 21:353-61. [PMID: 25482428 DOI: 10.1002/lt.24055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/30/2014] [Indexed: 02/07/2023]
Abstract
Recipients of liver transplantation (LT) are at increased risk for symptomatic coccidioidomycosis, primarily because of chronic immunosuppression and impaired cellular immunity. Unfortunately, no consensus exists regarding optimal posttransplant prophylaxis. In a prior study at our institution, we observed both de novo and recurrent coccidioidomycosis despite targeted antifungal prophylaxis. In response, in February 2011, we instituted a universal prophylaxis program consisting of fluconazole (200 mg daily) for the first posttransplant year. In the current study, we retrospectively reviewed the medical records of all patients who underwent LT between the initiation of universal prophylaxis and July 11, 2013. Patients receiving a second transplant or dual-organ transplant and those who died or did not have follow-up in the 12-month post-LT period were excluded. Data from the universal prophylaxis cohort were compared with previously published data from the targeted prophylaxis era. Of the 160 patients undergoing LT during the study period, 143 met criteria for data analysis. When compared with the 349 patients in the targeted prophylaxis cohort, patients in the universal prophylaxis group were older and had higher rates of pre-LT coccidioidomycosis, asymptomatic coccidioidal seropositivity, posttransplant diabetes mellitus, and renal insufficiency. Fluconazole-related toxicity occurred in 13 of the universal prophylaxis patients, 7 of whom were required to discontinue use of the medication. Coccidioidomycosis developed in 10 of the 391 patients (2.6%) in the targeted prophylaxis cohort and in none of the patients in the universal prophylaxis group (P = 0.04). These data strongly support the use of a 1-year antifungal prophylaxis regimen for LT recipients in endemic regions.
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Affiliation(s)
- Allon Kahn
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
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Surgical pathology of skeletal coccidioidomycosis: a clinical and histopathologic analysis of 25 cases. Am J Surg Pathol 2015; 38:1672-80. [PMID: 25007149 DOI: 10.1097/pas.0000000000000284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Skeletal coccidioidomycosis is a rare complication of pulmonary coccidioidomycosis that remains incompletely characterized, and its histopathologic features have not been systematically evaluated. All skeletal coccidioidal infections (2000 to 2012) were retrieved from the University of Arizona and Mayo Clinic in Arizona pathology archives. Clinical history and histologic features were reviewed. Among 25 patients (median age 40 y; 17 men), infections involved bones (2 cases), joints (6), or both (17), usually in the distal extremities (68%), especially the wrist (32%). History included previously documented coccidioidomycosis (13), autoimmune disease (8), diabetes (6), malignancy (4), and iatrogenic immunosuppression (10). Common symptoms (median 3 mo) included pain/arthralgia (21) and swelling (10). Cultures and serology were positive in 15 of 17 (88%) and 19 of 22 patients (86%), respectively. Treatment included surgical debridement(s) and chronic antifungal medication(s). Histologic review showed granulomas in all cases, ranging from poorly to well formed, with or without necrosis. Spherule density varied widely (mean 4.8/HPF; range <0.1 to 13.5/HPF). Composition of inflammatory infiltrates, degree of necrosis, and extent of fibrosis did not significantly differ between immunocompetent and immunocompromised patients. Eosinophils were only seen in one third of cases; when present, eosinophils were almost always rare. 10 patients experienced recurrent infection, 8 of whom were immunocompromised; the remaining patients recovered. In conclusion, distal extremities are the most common sites of skeletal coccidioidomycosis encountered by surgical pathologists. This condition is strongly associated with autoimmune disorders and immunosuppression. Spherules are sometimes rare, and multiple modalities including serology, culture, and histology may be required for diagnosis.
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Sil A, Andrianopoulos A. Thermally Dimorphic Human Fungal Pathogens--Polyphyletic Pathogens with a Convergent Pathogenicity Trait. Cold Spring Harb Perspect Med 2014; 5:a019794. [PMID: 25384771 PMCID: PMC4526722 DOI: 10.1101/cshperspect.a019794] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fungi are adept at changing their cell shape and developmental program in response to signals in their surroundings. Here we focus on a group of evolutionarily related fungal pathogens of humans known as the thermally dimorphic fungi. These organisms grow in a hyphal form in the environment but shift their morphology drastically within a mammalian host. Temperature is one of the main host signals that initiates their conversion to the "host" form and is sufficient in the laboratory to trigger establishment of this host-adapted developmental program. Here we discuss the major human pathogens in this group, which are Blastomyces dermatiditis, Coccidioides immitis/posadasii, Histoplasma capsulatum, Paracoccidioides brasiliensis/lutzii, Sporothrix schenckii, and Talaromyces marneffei (formerly known as Penicillium marneffei). The majority of these organisms are primary pathogens, with the ability to cause disease in healthy humans who encounter them in endemic areas.
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Affiliation(s)
- Anita Sil
- Department of Microbiology and Immunology, University of California, San Francisco, California 94143
| | - Alex Andrianopoulos
- Department of Genetics, The University of Melbourne, Victoria 3010, Australia
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Ashfaq A, Vikram HR, Blair JE, Jaroszewski DE. Video-assisted thoracoscopic surgery for patients with pulmonary coccidioidomycosis. J Thorac Cardiovasc Surg 2014; 148:1217-23. [DOI: 10.1016/j.jtcvs.2014.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/14/2014] [Accepted: 02/03/2014] [Indexed: 11/16/2022]
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