1
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Wilson DL, Zhou L, Sudano DG, Ashbeck EL, Kwoh CK, Krebs L, Sheer A, Smith J, Tudeen M, Lo‐Ciganic W. Risk of Coccidioidomycosis Infection Among Individuals Using Biologic Response Modifiers, Corticosteroids, and Oral Small Molecules. ACR Open Rheumatol 2024; 6:287-293. [PMID: 38425143 PMCID: PMC11089439 DOI: 10.1002/acr2.11654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE The study objective was to examine associations between the use of biologic response modifiers (BRMs), corticosteroids, and oral small molecules (OSMs) and subsequent coccidioidomycosis infection risk among US Medicare beneficiaries with rheumatic or autoimmune diseases. METHODS This retrospective cohort study used US 2011 to 2016 Medicare claims data. We identified geographic areas with endemic coccidioidomycosis (≥25 cases per 10,000 beneficiaries). Among beneficiaries having any rheumatic/autoimmune diseases, we identified those initiating BRMs, corticosteroids, and OSMs. Based on refill days supplied, we created time-varying exposure variables for BRMs, corticosteroids, and OSMs with a 90-day lag period after drug cessation. We examined BRMs, corticosteroids, and OSMs and subsequent coccidioidomycosis infection risk using multivariable Cox proportional hazard regression. RESULTS Among 135,237 beneficiaries (mean age: 67.8 years; White race: 83.1%; Black race: 3.6%), 5,065 had rheumatic or autoimmune diseases, of which 107 individuals were diagnosed with coccidioidomycosis during the study period (6.1 per 1,000 person-years). Increased risk of coccidioidomycosis was observed among beneficiaries prescribed any BRMs (17.7 per 1,000 person-years; adjusted hazard ratio [aHR] 3.94; 95% confidence interval [CI] 1.18-13.16), followed by individuals treated with only corticosteroids (12.2 per 1,000 person-years; aHR 2.29; 95% CI 1.05-5.03) compared to those treated with only OSMs (4.2 per 1,000 person-years). The rate of those treated with only OSMs was the same as that of beneficiaries without these medications. CONCLUSION Incidence of coccidioidomycosis was low among 2011 to 2016 Medicare beneficiaries with rheumatic or autoimmune diseases. BRM and corticosteroid users may have higher risks of coccidioidomycosis compared to nonusers, warranting consideration of screening for patients on BRMs and corticosteroids in coccidioidomycosis endemic areas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wei‐Hsuan Lo‐Ciganic
- University of Pittsburgh, Pittsburgh, Pennsylvania and North Florida/South Georgia Veterans Health System, Geriatric Research Education and Clinical CenterGainesvilleFlorida
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2
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Tamura H, Suzuki H, Yamanaka T, Kaiho T, Inage T, Ito T, Tanaka K, Sakairi Y, Wada H, Yoshino I. Surgical treatment for chronic pulmonary coccidioidomycosis: a retrospective study from a single institution. Surg Today 2024; 54:325-330. [PMID: 37555929 DOI: 10.1007/s00595-023-02736-3] [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: 05/10/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Coccidioidomycosis, caused by the Coccidioides species, is a well-known disease in the Southwestern United States and North Mexico, with scattered reports in Latin America countries. While this disease is still rare in Japan and other Asian countries, its incidence has been increasing over the last two decades. Coccidioides species are highly infectious and require caution when encountered. This study presents a case series of chronic pulmonary coccidioidomycosis surgically treated at a single institution. METHODS We conducted a retrospective chart review of six patients who underwent lung resection for pulmonary coccidioidomycosis at Chiba University Hospital between January 2007 and December 2021. RESULTS All six patients had travelled to the Southwestern United States. Preoperative serology was negative for the anti-Coccidioides antibody in four patients and positive in two. Chest computed tomography revealed a single, well-defined round nodule in all patients. Preoperative biopsy taken from three patients failed to obtain a definitive diagnosis. Histopathological examination of the resected pulmonary nodules revealed granulomas that contained numerous spherules with many endospores, thereby confirming the diagnosis of pulmonary coccidioidomycosis. CONCLUSIONS Pulmonary coccidioidomycosis should be suspected based on travel history and radiological findings. Meticulous care should be taken during specimen processing to prevent cross infection.
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Affiliation(s)
- Hajime Tamura
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Takahiro Yamanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Taisuke Kaiho
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
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3
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Lanks C. Fulminant Disseminated Coccidioidomycosis With Histoplasma Antigen Cross-Reactivity. Cureus 2024; 16:e58129. [PMID: 38738009 PMCID: PMC11088875 DOI: 10.7759/cureus.58129] [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: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
A 79-year-old man with type II diabetes mellitus and recently diagnosed idiopathic thrombocytopenic purpura presented to the Emergency Department with progressive dyspnea over the course of two weeks. He was found to have diffuse miliary nodules, dense cavitary consolidation, and widespread cystic changes on chest imaging and died within 48 hours of admission to the hospital. His serum Coccidioides antibody and urine Histoplasma antigen were both positive. He later grew Coccidioides immitis from the blood, supporting the theory that Histoplasma positivity was likely the result of antigen test cross-reactivity. Coccidioidomycosis typically presents with mild, self-limited symptoms, but may also disseminate rapidly, causing fulminant, life-threatening disease. Prompt recognition of risk factors for fulminant coccidioidomycosis and understanding flaws in serologic testing are essential to the appropriate diagnosis and management of this disease.
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Affiliation(s)
- Charles Lanks
- Pulmonary and Critical Care Medicine, Harbor University of California, Los Angeles Medical Center, Torrance, USA
- Respiratory Medicine, Lundquist Institute for Biomedical Innovation, Torrance, USA
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4
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Wisniewski P, McCool I, Walsh JC, Ausman C, Edmondson J, Perry A, Ewers EC, Maves RC. Fatal septic shock due to disseminated coccidioidomycosis: a case series and review of the literature. BMC Infect Dis 2023; 23:430. [PMID: 37365503 DOI: 10.1186/s12879-023-08379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic. CONCLUSIONS Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.
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Affiliation(s)
- Piotr Wisniewski
- Operational Infectious Diseases Directorate, Naval Health Research Center, San Diego, CA, USA
- Uniformed Services University School of Medicine, Bethesda, MD, USA
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, USA
| | - Isaac McCool
- Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - John C Walsh
- Department of Pathology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Chelsea Ausman
- Uniformed Services University School of Medicine, Bethesda, MD, USA
| | | | - Alexandra Perry
- Department of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, CA, USA
| | - Evan C Ewers
- Uniformed Services University School of Medicine, Bethesda, MD, USA
- Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Ryan C Maves
- Uniformed Services University School of Medicine, Bethesda, MD, USA.
- Sections of Infectious Diseases and Critical Care Medicine, Wake Forest University School of Medicine, North Carolina Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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5
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Abdollahi Zarandi P, Antony S, Sotelo-Rafiq E. A Case of Primary Osteomyelitis of the Rib With Involvement of the Chest Wall, Presenting as a Non-Healing Abscess. Cureus 2022; 14:e26974. [PMID: 35989774 PMCID: PMC9381883 DOI: 10.7759/cureus.26974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Coccidioidomycosis of the chest wall is a rare finding and diagnosis is often delayed. We report a case of chest wall abscess with underlying osteomyelitis and an expansile lytic lesion of the left fourth rib in a young and immunocompetent African American male. Initially, the diagnostic assumption gravitated towards bone malignancy, but the diagnosis of coccidioidomycosis was made when the culture results from the bone biopsy specimen confirmed Coccidioides immitis as the causative agent. The aim of this unique case is to demonstrate that as an emerging infectious agent, Coccidioides immitis is a known cause of chest wall abscess and should be considered among the differential diagnosis by clinicians.
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6
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Sharifi S, Sharma R, Heidari A, Johnson RH. Disseminated Coccidioidomycosis: Cutaneous, Soft Tissue, Osseous, and "Shotgun Intraparenchymal" Brain Disease. J Investig Med High Impact Case Rep 2022; 10:23247096221075906. [PMID: 35199591 PMCID: PMC8883362 DOI: 10.1177/23247096221075906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 11/25/2022] Open
Abstract
Coccidioidomycosis is a disease found in the southwestern United States and caused by inhalation of arthroconidia of Coccidioides immitis and posadasii. Although the disease is most commonly asymptomatic or respiratory, it has a propensity to disseminate to any tissue in the body with the most common being skin, bone, joints, and central nervous system. This case demonstrates the dissemination of coccidioidomycosis to several foci along with a rare form of parenchymal dissemination with an unusual neuroradiological finding.
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Affiliation(s)
| | | | - Arash Heidari
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, USA
| | - Royce H. Johnson
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, USA
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7
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Sous R, Levkiavska Y, Sharma R, Jariwal R, Amodio D, Johnson RH, Heidari A, Kuran R. Two Cases of Miliary and Disseminated Coccidioidomycosis Following Glucocorticoid Therapy and Literature Review. J Investig Med High Impact Case Rep 2022; 10:23247096211051928. [PMID: 35225034 PMCID: PMC8891939 DOI: 10.1177/23247096211051928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 49-year-old man with no significant past medical history received dexamethasone as part of his treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Less than 3 weeks later, the patient developed acute respiratory distress syndrome. Radiological and serological testing led to a diagnosis of acute hypoxic miliary coccidioidomycosis. A 52-year-old man with a past medical history of chronic kidney disease (CKD) was treated with prednisone for focal segmental glomerulosclerosis (FSGS). Within 2 weeks, this patient developed bilateral lower extremity weakness. Radiology, serology, and lumbar puncture proved a diagnosis of reactivated coccidioidomycosis with miliary pattern and coccidioidomycosis meningoencephalitis with arachnoiditis. Whether treatment with glucocorticoids caused reactivation of coccidioidomycosis is discussed in this case series.
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Affiliation(s)
| | | | - Rupam Sharma
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
| | | | - Daniela Amodio
- Rio Bravo Family Medicine Residency Program, Bakersfield, CA, USA
| | - Royce H Johnson
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
| | - Arash Heidari
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
| | - Rasha Kuran
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
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8
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O'Shaughnessy E, Yasinskaya Y, Dixon C, Higgins K, Moore J, Reynolds K, Ampel NM, Angulo D, Blair JE, Catanzaro A, Galgiani JN, Garvey E, Johnson R, Larwood DJ, Lewis G, Purdie R, Rex JH, Shubitz LF, Stevens DA, Page SJ, Shukla SJ, Farley JJ, Nambiar S. FDA Public Workshop Summary-Coccidioidomycosis (Valley Fever): Considerations for Development of Antifungal Drugs. Clin Infect Dis 2021; 74:2061-2066. [PMID: 34651656 DOI: 10.1093/cid/ciab904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Coccidioidomycosis is a fungal disease endemic to the southwestern United States, Mexico, and Central and South America. Prevalence rates are increasing steadily and new endemic areas of Coccidioides are emerging. Standard treatment is often administered for months to decades, and intolerance to medications and treatment failures are common. No new treatments for coccidioidomycosis have been approved in the U.S. in nearly 40 years. On August 5, 2020, the U.S. Food and Drug Administration convened experts in coccidioidomycosis from academia, industry, patient groups and other government agencies to discuss the disease landscape and strategies to facilitate product development for treatment of coccidioidomycosis. This paper summarizes the key topics concerning drug development for coccidioidomycosis presented by speakers and panelists during the workshop, such as unmet need, trial designs, endpoints, incentives, research and development support, and collaborations to facilitate antifungal drug development.
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Affiliation(s)
- Elizabeth O'Shaughnessy
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Yuliya Yasinskaya
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Cheryl Dixon
- Division of Biometrics IV, Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | - Karen Higgins
- Division of Biometrics IV, Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | - Jason Moore
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, MD, USA
| | - Kellie Reynolds
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, MD, USA
| | - Neil M Ampel
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | | | | | | | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | | | - Royce Johnson
- Valley Fever Institute, Kern Medical, Bakersfield, CA, USA
| | | | | | - Rob Purdie
- Valley Fever Institute, Kern Medical, Bakersfield, CA, USA
| | | | - Lisa F Shubitz
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, and Div. of Infectious Diseases and Geographic Medicine, Dept. of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sunita J Shukla
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - John J Farley
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Sumathi Nambiar
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
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9
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Agarwal M, Nokes B, Blair JE. Coccidioidomycosis and Solid Organ Transplantation. CURRENT FUNGAL INFECTION REPORTS 2021. [DOI: 10.1007/s12281-021-00425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Abstract
Coccidioidomycosis, caused by the dimorphic pathogenic fungi Coccidioides immitis and Coccidioides posadassi, is endemic to the southwestern United states and Central and South America. The incidence of coccidioidomycosis continues to increase. Coccidioidomycosis is typically a self-limiting influenza-like respiratory illness; however, it can lead to disseminated disease outside of the lungs. Not all nondisseminated cases require therapy, but antifungal therapy is typically beneficial requiring treatment ranging from months to lifelong. Clinical factors related to treatment decisions include severity of symptoms, radiography, coccidioidomycosis serologic results, and concurrent medical problems including immunosuppression. This review summarizes the epidemiology, clinical manifestations, and treatment options.
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Affiliation(s)
- Derek J Bays
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, PSSB, Suite G500, Sacramento, CA 95817, USA; Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA.
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11
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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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12
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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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13
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Merkhofer RM, Klein BS. Advances in Understanding Human Genetic Variations That Influence Innate Immunity to Fungi. Front Cell Infect Microbiol 2020; 10:69. [PMID: 32185141 PMCID: PMC7058545 DOI: 10.3389/fcimb.2020.00069] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/12/2020] [Indexed: 12/30/2022] Open
Abstract
Fungi are ubiquitous. Yet, despite our frequent exposure to commensal fungi of the normal mammalian microbiota and environmental fungi, serious, systemic fungal infections are rare in the general population. Few, if any, fungi are obligate pathogens that rely on infection of mammalian hosts to complete their lifecycle; however, many fungal species are able to cause disease under select conditions. The distinction between fungal saprophyte, commensal, and pathogen is artificial and heavily determined by the ability of an individual host's immune system to limit infection. Dramatic examples of commensal fungi acting as opportunistic pathogens are seen in hosts that are immune compromised due to congenital or acquired immune deficiency. Genetic variants that lead to immunological susceptibility to fungi have long been sought and recognized. Decreased myeloperoxidase activity in neutrophils was first reported as a mechanism for susceptibility to Candida infection in 1969. The ability to detect genetic variants and mutations that lead to rare or subtle susceptibilities has improved with techniques such as single nucleotide polymorphism (SNP) microarrays, whole exome sequencing (WES), and whole genome sequencing (WGS). Still, these approaches have been limited by logistical considerations and cost, and they have been applied primarily to Mendelian impairments in anti-fungal responses. For example, loss-of-function mutations in CARD9 were discovered by studying an extended family with a history of fungal infection. While discovery of such mutations furthers the understanding of human antifungal immunity, major Mendelian susceptibility loci are unlikely to explain genetic disparities in the rate or severity of fungal infection on the population level. Recent work using unbiased techniques has revealed, for example, polygenic mechanisms contributing to candidiasis. Understanding the genetic underpinnings of susceptibility to fungal infections will be a powerful tool in the age of personalized medicine. Future application of this knowledge may enable targeted health interventions for susceptible individuals, and guide clinical decision making based on a patient's individual susceptibility profile.
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Affiliation(s)
- Richard M Merkhofer
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Bruce S Klein
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States.,Department of Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, United States
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14
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Abstract
Since its description nearly 130 years ago, hundreds of studies have deepened our understanding of coccidioidomycosis, also known as valley fever (VF), and provided useful diagnostic tests and treatments for the disease caused by the dimorphic fungi Coccidioides spp. In general, most of the literature has addressed well-established infections and has described patients who have experienced major complications. In contrast, little attention has been given to the earliest consequences of the pathogen-host interaction and its implications for disease manifestation, progression, and resolution. The purpose of this review is to highlight published studies on early coccidioidomycosis, identify gaps in our knowledge, and suggest new or former research areas that might be or remain fertile ground for insight into the early stages of this invasive fungal disease.
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15
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James AE, McCall JR, Petersen KR, Wohrle RD, Oltean HN. A survey of veterinarians' knowledge, attitudes and practices regarding an emerging disease: Coccidioidomycosis in Washington State. Zoonoses Public Health 2019; 67:25-34. [PMID: 31541564 DOI: 10.1111/zph.12651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/07/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022]
Abstract
Coccidioides immitis is an emerging fungal pathogen in Washington State (WA). While the geographical boundaries of C. immitis in WA have not been well characterized, human infections have resulted from exposure in the south-central region of the state. Since 2010, only one dog has been identified as a probable locally acquired animal case, despite pilot canine serological surveys from south-central WA revealing a 9.8% seroprevalence. On the suspicion that clinical animal cases may be underdiagnosed and/or underreported, we assessed WA veterinarians' knowledge, attitudes and practices regarding coccidioidomycosis. All veterinarians with active licenses in WA were invited to complete a self-administered, web-based survey from November 2018 to January 2019. Four hundred and twenty-five of 2,211 (19.2%) veterinarians returned the survey and were eligible for inclusion in the final analysis. Nearly, all respondents (98.8%) had heard of coccidioidomycosis, but only 31.5% and 25.6% knew that locally acquired animal and human cases, respectively, had been reported in WA. Only half (52.6%) of participants knew that the disease was reportable. Fewer than 20% of respondents reported confidence that their knowledge of coccidioidomycosis was up to date, and 76.9% "never" or "rarely" considered the risk of disease in their patients. A statistically significant predictor of a high knowledge score (≥70%), however, included practicing in endemic counties where the Washington State Department of Health had previously delivered outreach and education services. While the results suggest some success with these activities, it is clear that information on the emergence of coccidioidomycosis is not adequately reaching veterinary practitioners in WA. The data support that more frequent CE opportunities, and dissemination of public health communications through veterinary-specific modalities, would help fill the knowledge gap. In turn, improved diagnosis and reporting of animal cases would assist in our overall understanding the epidemiology of coccidioidomycosis in WA.
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Affiliation(s)
- Allison E James
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - James R McCall
- Social and Economic Sciences Research Center, Department of Sociology, Washington State University, Pullman, WA, USA
| | - Kristen R Petersen
- Social and Economic Sciences Research Center, Washington State University, Pullman, WA, USA
| | - Ron D Wohrle
- Environmental Public Health Division, Washington State Department of Health, Olympia, WA, USA
| | - Hanna N Oltean
- Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, WA, USA
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Matlock M, Hopfer S, Ogunseitan OA. Communicating Risk for a Climate-Sensitive Disease: A Case Study of Valley Fever in Central California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3254. [PMID: 31491843 PMCID: PMC6765846 DOI: 10.3390/ijerph16183254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022]
Abstract
Valley Fever, or Coccidioidomycosis, a fungal respiratory disease, is prevalent with increasing incidence in the Southwestern United States, especially in the central region of California. Public health agencies in the region do not have a consistent strategy for communication and health promotion targeting vulnerable communities about this climate-sensitive disease. We used the behavior adaptation communication model to design and conduct semi-structured interviews with representatives of public health agencies in five California counties: Fresno, Kern, Kings, San Luis Obispo, and Tulare County. While none of the agencies currently include climate change information into their Valley Fever risk messaging, the agencies discuss future communication methods similar to other health risk factors such as poor air quality days and influenza virus season. For political reasons, some public health agencies deliberately avoided the use of climate change language in communicating health risk factors to farmers who are particularly vulnerable to soil and dust-borne fungal spores. The effectiveness of health communication activities of the public health agencies has not been measured in reducing the prevalence of Valley Fever in impacted communities. Given the transboundary nature of climate influence on Valley Fever risk, a concerted and consistent health communication strategy is expected to be more effective than current practices.
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Affiliation(s)
- Melissa Matlock
- Department of Population Health and Disease Prevention, Program in Public Health; Irvine, CA 92697, USA.
| | - Suellen Hopfer
- Department of Population Health and Disease Prevention, Program in Public Health; Irvine, CA 92697, USA.
| | - Oladele A Ogunseitan
- Department of Population Health and Disease Prevention, Program in Public Health; Irvine, CA 92697, USA
- School of Social Ecology; University of California, Irvine, CA 92697, USA
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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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Nicas M. Occupational Coccidioidomycosis in a heavy equipment operator. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:841-846. [PMID: 30230974 DOI: 10.1080/15459624.2018.1524149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/11/2018] [Indexed: 06/08/2023]
Abstract
This article describes a case of Coccidioidomycosis pneumonia in an individual who worked in the McKittrick Oil Field, Kern County, California, for 15 days during an approximate 1-month period in 2016. Coccidioidomycosis is caused by inhaling spores of Coccidioides immitis (C. immitis), a soil fungus endemic in regions of California, most notably the San Joaquin Valley. In California, Kern County has the highest incidence rate of Coccidioidomycosis, and the McKittrick Oil Field lies within the most highly endemic part of Kern County. The affected individual, who resided in a nonendemic state, traveled to Kern County to operate heavy equipment and also perform some laborer tasks. He experienced substantial exposure to soil dust without wearing adequate respiratory protection. Consideration of the relative amounts of soil dust exposure due to the individual's oil field work vs. ambient air permits a conclusion that his infection was work-related. In addition to respiratory protection, some measures needed to reduce soil dust exposure during construction work in areas endemic for C. immitis are discussed.
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Affiliation(s)
- Mark Nicas
- a School of Public Health, University of California , Berkeley California
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Complications and Management of a Rare Case of Disseminated Coccidioidomycosis to the Vertebral Spine. Case Rep Infect Dis 2018; 2018:8954016. [PMID: 30425868 PMCID: PMC6218755 DOI: 10.1155/2018/8954016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022] Open
Abstract
Coccidioidomycosis, also known as San Joaquin Valley Fever or Valley Fever, is mostly a pulmonary infection caused by inhalation of spores in an endemic region. Dissemination to bone, joints, meninges, and skin occurs less than one percent of the time. Skeletal involvement accounts for approximately half of the disseminated coccidioidomycosis with the vertebrae as the most common skeletal region. We present a very rare case of disseminated coccidioidomycosis with osteomyelitis and compression fracture of the lumbar vertebral body. This case depicts some of the potential issues that can arise in managing coccidioidomycosis, especially when noncompliance to initial azoles occurs, that can lead to dissemination and complicated bone infections necessitating surgical intervention along with continuous medical therapy.
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Abukamleh H, Heidari A, Petersen G, Natarajan P, Yakoub G, Cobos E, Johnson R. Erythema Sweetobullosum: A Reactive Cutaneous Manifestation of Coccidioidomycosis. J Investig Med High Impact Case Rep 2018; 6:2324709618796659. [PMID: 30159356 PMCID: PMC6109837 DOI: 10.1177/2324709618796659] [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] [Received: 03/16/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 11/22/2022] Open
Abstract
Reactive cutaneous coccidioidal skin manifestations are commonly noticed during the early stage of coccidioidomycosis. These skin lesions are devoid of any active coccidioidal organism, and the immune trigger mechanisms are not elucidated. We describe 6 cases of unusual reactive cutaneous coccidioidal manifestation, characterized by painful vesiculobullous lesions known as erythema sweetobullosum. The biopsy of the lesions revealed neutrophilic dermatosis with inflammatory cells resulting in a cleft and elevation of the most superficial layer of the skin forming a bulla. The reactive cutaneous lesion is self-limited and requires no specific therapy.
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The Orotomide Olorofim Is Efficacious in an Experimental Model of Central Nervous System Coccidioidomycosis. Antimicrob Agents Chemother 2018; 62:AAC.00999-18. [PMID: 29941638 DOI: 10.1128/aac.00999-18] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Olorofim (formerly F901318) is an advanced analog of the orotomide class that inhibits fungal pyrimidine biosynthesis. We evaluated the in vitro and in vivo activities of olorofim against Coccidioides species. In vitro activity was assessed against 59 clinical Coccidioides isolates. Central nervous system infections were established in mice via intracranial inoculation with Coccidioides immitis arthroconidia. Oral therapy began 48 h postinoculation and consisted of vehicle control, olorofim daily doses of 20 mg/kg (6.67 mg/kg three times daily or 10 mg/kg twice daily) or 40 mg/kg (13.3 mg/kg three times daily or 20 mg/kg twice daily), or fluconazole (25 mg/kg twice daily). Treatment continued for 7 and 14 days in the fungal burden and survival arms, respectively. Fungal burdens were assessed by CFU counts in brains. Olorofim demonstrated potent in vitro activity (MIC range, ≤0.008 to 0.06 μg/ml). Survival was significantly enhanced in mice treated with olorofim. Reductions in brain tissue fungal burdens were also observed on day 9 in the olorofim-treated groups. Improvements in survival and reductions in fungal burdens also occurred with fluconazole. More frequent dosing of olorofim was associated with enhanced survival and greater reductions in fungal burdens. In the group treated with 13.3 mg/kg olorofim three times daily, fungal burdens remained low on day 30 (15 days after treatment was stopped), with undetectable levels in 7 of 10 mice. In contrast, fungal burdens rebounded in all other groups after therapy stopped. Olorofim was highly active in vitro and in vivo against Coccidioides These results demonstrate that olorofim may have a role in the treatment of coccidioidomycosis.
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Abstract
Coccidioidomycosis is the major systemic mycoses, considered to be 1 of the most infectious fungal diseases. In symptomatic patients, the most common manifestation is pulmonary disease, but many other organs can be affected. Disseminated disease occurs in 1%-5% of all patients affected by coccidioidomycosis and can affect any organ, with the skin, central nervous system, and musculoskeletal system being reported as the most prevalent. Here, we report a 42-year-old male farmer from the west Texas who presented with an approximately 2-month history of progressive shortness of breath and dyspnea on exertion, weight loss, and night sweats. He was treated with various antibiotics for possible upper respiratory tract infection without symptomatic improvement. Computed tomography of the chest revealed numerous subcentimeter noncalcified pulmonary nodules scattered throughout both lungs with extensive mediastinal and bilateral hilar lymphadenopathy. The patient was referred to our hospital for further evaluation of suspected metastatic lung disease. Physical examination revealed an erythematous 1.2 cm nodule on his left medial eyebrow. Skin biopsy of the lesion revealed prominent squamous epithelial hyperplasia with basal keratinocytic atypia and associated mixed inflammatory infiltrate and scattered large thick-walled spherules containing variable-sized endospores, predominantly within the multinucleated giant cells. Special stain Periodic acid-Schiff tissue culture studies confirmed these to be Coccidioides immitis. After appropriate treatment with antifungal therapy for 5.5 months, his symptoms have improved with complete disappearance of lung nodules and a partially cavitated (1.1 × 1.1 cm) lesion in the left upper lung confirmed by follow-up chest computed tomography. With this report, the authors highlight disseminated coccidioidomycosis, a great mimicker of metastatic lung disease, which was diagnosed by skin biopsy, to ensure its prompt recognition and appropriate antifungal therapy.
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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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24
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Epidemiology of fungal infections in China. Front Med 2018; 12:58-75. [DOI: 10.1007/s11684-017-0601-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
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25
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Nicas M. A point-source outbreak of Coccidioidomycosis among a highway construction crew. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:57-62. [PMID: 29053941 DOI: 10.1080/15459624.2017.1383612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Coccidioidomycosis is an infection caused by inhaling spores of the soil fungus Coccidioides immitis (hereafter termed Cocci). Cocci is endemic in certain areas of California. When soil containing the fungus is disturbed, as during earth-moving activities, respirable Cocci spores can become airborne and be inhaled by persons in the vicinity. This article describes a cluster of seven Cocciodioidomycosis cases among a highway construction crew that occurred in June/July 2008 in Kern County, CA, which is among the most highly endemic regions for Cocci in California. The exposures spanned no more than seven work days, and illness developed within two to three weeks of the exposures. Given the common source of exposure (soil dust generated at the work site) and the multiple cases occurring close in time, the cluster can also be termed a "point-source outbreak." The contractor was not informed of the infection risk and did not take adequate precautions against dust exposure. Appropriate engineering/administrative controls and respiratory protection are discussed.
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Affiliation(s)
- Mark Nicas
- a School of Public Health, University of California , Berkeley , California
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27
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Shahab R, Amra NK, Rabah R, Saunar J, Soriano J, Al-Tawfiq JA. Recurrence of cutaneous coccidioidomycosis 6 years after valley fever: A case presentation and literature review. Diagn Microbiol Infect Dis 2017; 89:218-221. [PMID: 28811115 DOI: 10.1016/j.diagmicrobio.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/23/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
Coccidioidomycosis is usually acquired by inhalation of spores of Coccidioides immitis and C. posadasii. The disease ranges from a self-limited acute pneumonia (Valley Fever) to a disseminated disease. We present a 44-year-old healthy male who had patchy hair loss of several months duration resembling discoid lupus. He developed a firm non-scaly red plaque on the right forehead. Initial biopsy showed spongiotic dermatitis, and he was treated with systemic steroids. He then developed forehead and periorbital cellulitis and was treated with systemic antibiotics. A second biopsy showed fungal hyphae, and he was treated with itraconazole 200mg bid for 4months beyond clinical resolution. A year later, he presented with intermittent swelling of the right forehead lesion and worsening of the scalp lesions. A forehead biopsy showed interface dermatitis and negative PAS stain for fungi. Scalp biopsy was highly suggestive of discoid lupus and he was started on plaquenil. Many months later, a third biopsy showed fungal infection, and the culture grew C. immitis. He was treated with itraconazole. Retrospectively, the patient gave a history of Valley fever 6 years back when he was in Arizona, USA.
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Affiliation(s)
- Rana Shahab
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Nasir K Amra
- Pathology department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Rola Rabah
- Pathology department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Justin Saunar
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Joan Soriano
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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28
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Montgomery MW, Yawetz S, Levy BD, Loscalzo J. Back to the History. N Engl J Med 2017; 376:1783-1788. [PMID: 28467866 DOI: 10.1056/nejmcps1607608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mary W Montgomery
- From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Sigal Yawetz
- From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Bruce D Levy
- From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
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Ho J, Fowler P, Heidari A, Johnson RH. Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis. Clin Infect Dis 2017; 64:519-524. [PMID: 27927853 DOI: 10.1093/cid/ciw794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022] Open
Abstract
Coccidioidal meningitis (CM) is a devastating complication of coccidioidomycosis. Since the late 1950s, intrathecal (IT) amphotericin B deoxycholate (AmBd) has been successfully used to treat and often cure this disease, reducing mortality rates from 100% to approximately 30%. The introduction of azoles further revolutionized the treatment of coccidioidal infections. However, IT AmBd remains the only known curative option in the management of CM. While the use of IT AmBd is well described in many articles, few discuss the actual methods behind preparation, titration, and dosing strategies utilized. The practitioners at Kern Medical (Bakersfield, California) have >60 years of experience in the utilization of IT AmBd and the treatment of CM. This article describes the practice experience in the treatment of CM, preparation of IT AmBd, and the different dosing strategies used in regard to route of administration (ie, cisternal, lumbar, ventricular).
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Affiliation(s)
- Jackie Ho
- Department of Pharmacy, Kern Medical, Bakersfield, California, USA
| | - Pete Fowler
- Department of Pharmacy, Kern Medical, Bakersfield, California, USA
| | - Arash Heidari
- Department of Medicine, Kern Medical, Bakersfield, California, USA.,David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Royce H Johnson
- Department of Medicine, Kern Medical, Bakersfield, California, USA.,David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Chen L, Dahiya N, Zarka MA. Thyroid fine-needle aspiration of an immunocompromised patient: Cytomorphological clues. Cytojournal 2017; 14:3. [PMID: 28331528 PMCID: PMC5349017 DOI: 10.4103/1742-6413.200934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Longwen Chen
- Address: Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Matthew A Zarka
- Address: Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, USA
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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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Nigo M, Quarshie C, Tarrand J, Fanale MA, Taremi M. Mass Invading Thoracic Vertebrae in a Liver Transplant Recipient. Clin Infect Dis 2017. [DOI: 10.1093/cid/ciw777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alfreijat M, Wilhelmi B. A case of a positive coccidioides stool culture in an immunocompetent patient with disseminated coccidioidomycosis. IDCases 2017; 8:89-91. [PMID: 28507906 PMCID: PMC5429226 DOI: 10.1016/j.idcr.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 11/24/2022] Open
Abstract
Coccidioidomycosis (CM) is an infection caused by the coccidioides fungus. The spectrum of the disease ranges from a mild upper respiratory illness to severe disseminated infection that could affects the bones, joints, skin, central nervous system, and the gastrointestinal tract. Previous reports of a positive stool culture in the setting of disseminated CM are extremely rare. Herein, we describe a case of a 43-year-old immunocompetent patient with disseminated CM and evidence of positive coccidioides stool culture.
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Disseminated coccidioidomycosis with multifocal musculoskeletal disease involvement. Radiol Case Rep 2016; 12:141-145. [PMID: 28228898 PMCID: PMC5310389 DOI: 10.1016/j.radcr.2016.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
We report a rare case of disseminated coccidioidomycosis with multifocal musculoskeletal involvement. The patient presented to the emergency department with left shoulder pain and swelling. Magnetic resonance imaging of the left shoulder revealed enhancing soft tissue masses, bony lesions, and fluid collections in and around the glenohumeral joint with involvement of the proximal humerus, glenoid, and rotator cuff musculature. Multiple additional areas of involvement were subsequently discovered. Fungal cultures confirmed coccidioidomycosis infection at all surgical sites with superimposed polymicrobial bacterial infection in the left shoulder.
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Labuschagne H, Burns C, Martinez S, Carrillo M, Waggoner M, Schwanninger I, Maher J, Hampton M, Flores-Guardado J, Schlabritz-Loutsevitch NE. Coccidioidomycosis in pregnancy: Case report and literature review of associated placental lesions. Case Rep Womens Health 2016; 12:5-10. [PMID: 29629302 PMCID: PMC5886004 DOI: 10.1016/j.crwh.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Coccidioidomycosis is an endemic fungal infection found most commonly in the Southwestern United States, Northwestern Mexico, and parts of Central and South America. Although infection is relatively uncommon during pregnancy, it is imperative to have an index of suspicion in order to diagnose and begin timely treatment to prevent dissemination and dire consequences. CASE REPORT A 33-year-old Hispanic female was evaluated after she was involved in an automobile accident. Radiographic evaluation showed a 3.2 × 3.2 cm cavitary thick-walled lesion. A biopsy was negative for malignancy. Evaluation was positive for coccidioidomycosis by complement fixation reaction. Four months later, the patient presented 7 weeks into a pregnancy with massive hemoptysis. Bronchoscopy revealed bleeding from the right upper lobe and emergency embolization was performed. The patient had a spontaneous abortion 9 days after admission. The right upper and middle lobes of the lung were resected due to continuous bleeding. A subsequent pregnancy was un-eventful. Coccidioidomycosis titers remained negative throughout the second pregnancy. DISCUSSION This case demonstrates the potential for severe pulmonary coccidioidomycosis and vascular strain of pregnancy-associated vascular expansion in the first trimester of pregnancy and the possibility of a favorable pregnancy outcome in subsequent pregnancies after appropriate treatment. The route of feto-maternal transmission and placental lesions in coccidioidomycosis are discussed.
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Affiliation(s)
- Heloise Labuschagne
- Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - C. Burns
- Department of Pathology, Medical Center Hospital, Odessa, TX, USA
| | - Stacy Martinez
- Department of Academic Affairs, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Maira Carrillo
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Melissa Waggoner
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Irene Schwanninger
- Department of Academic Affairs, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - James Maher
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Moss Hampton
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Javier Flores-Guardado
- Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Abstract
Dimorphic fungi cause several endemic mycoses which range from subclinical respiratory infections to life-threatening systemic disease. Pathogenic-phase cells of Histoplasma, Blastomyces, Paracoccidioides and Coccidioides escape elimination by the innate immune response with control ultimately requiring activation of cell-mediated immunity. Clinical management of disease relies primarily on antifungal compounds; however, dimorphic fungal pathogens create a number of challenges for antifungal drug therapy. In addition to the drug toxicity issues known for current antifungals, barriers to efficient drug treatment of dimorphic fungal infections include natural resistance to the echinocandins, residence of fungal cells within immune cells, the requirement for systemic delivery of drugs, prolonged treatment times, potential for latent infections, and lack of optimized standardized methodology for in vitro testing of drug susceptibilities. This review will highlight recent advances, current therapeutic options, and new compounds on the horizon for treating infections by dimorphic fungal pathogens.
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Affiliation(s)
| | - Chad A Rappleye
- a Department of Microbiology , Ohio State University , Columbus , OH , USA
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Lee JM, Graciano AL, Dabrowski L, Kuzmic B, Tablizo MA. Coccidioidomycosis in infants: A retrospective case series. Pediatr Pulmonol 2016; 51:858-62. [PMID: 26829719 DOI: 10.1002/ppul.23387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In contrast to adults, coccidioidomycosis is a rare disease in infants and the mechanisms of disease acquisition are not well described in infants. The purpose of this study was to describe the clinical presentation, treatment, and outcome of pulmonary coccidioidomycosis in infants in an endemic area. METHODS We performed a retrospective observational study of all patients less than 12 months of age admitted to a tertiary free standing children's hospital from 2003-2012 diagnosed with coccidioidomycosis. RESULTS Thirteen infants were hospitalized during the study period. The majority of the patients presented with upper and/or lower respiratory tract infection. The most common presenting symptoms included fever (77%), cough (61%), and respiratory distress (38%). Disseminated disease, included pericardial effusion, neck abscess, and lesions in the cerebellum, basal ganglia and left temporoparietal skull. Fluconazole was the initial, antifungal agent used. Amphotericin B was reserved for significant lung disease and disseminated cases. Failed response to fluconazole and amphotericin B were treated with a combination of voriconazole and caspofungin. Average length of treatment was 4 years. All patients survived to hospital discharge. The majority of the patients had resolution of chest radiograph and coccidiodal complement fixing antibody titers. DISCUSSION Infant coccidioidomycosis has a non-specific presentation and can mimic common infant respiratory illnesses. In endemic areas, coccidioidomycosis should be considered in the differential diagnosis of infants with pulmonary symptoms unresponsive to conventional treatment. Pediatr Pulmonol. 2016;51:858-862. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jessica M Lee
- University of California at San Francisco, Fresno, California.,Valley Children's Hospital, Madera, California
| | - Ana Lia Graciano
- University of California at San Francisco, Fresno, California.,Department of Anesthesia and Critical Care, Valley Children's Hospital, Madera, California
| | - Lukasz Dabrowski
- University of California at San Francisco, Fresno, California.,Southern Illinois Healthcare, Carbondale, Illinois
| | - Brenik Kuzmic
- Department of Pharmacy, Valley Children's Hospital, Madera, California
| | - Mary Anne Tablizo
- University of California at San Francisco, Fresno, California.,Department of Pulmonology, Valley Children's Hospital, Madera, California
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Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2016; 63:e112-46. [PMID: 27470238 DOI: 10.1093/cid/ciw360] [Citation(s) in RCA: 319] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
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Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula. Case Rep Infect Dis 2016; 2016:8715405. [PMID: 27313922 PMCID: PMC4893591 DOI: 10.1155/2016/8715405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/08/2016] [Indexed: 11/17/2022] Open
Abstract
Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.
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Egan K, Hanks DK, Kim DW, Murr AH. Coccidioidomycosis presenting as midline neck mass. Otolaryngol Head Neck Surg 2016; 136:147-8. [PMID: 17210356 DOI: 10.1016/j.otohns.2006.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Kristin Egan
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco, CA 94117, USA.
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41
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Nelson JK, Giraldeau G, Montoya JG, Deresinski S, Ho DY, Pham M. Donor-Derived Coccidioides immitis Endocarditis and Disseminated Infection in the Setting of Solid Organ Transplantation. Open Forum Infect Dis 2016; 3:ofw086. [PMID: 27413765 PMCID: PMC4940450 DOI: 10.1093/ofid/ofw086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 01/07/2023] Open
Abstract
Background. Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant. Methods. We present a unique case of donor-derived Coccidioides immitis endocarditis and disseminated infection in a heart transplant patient. We also conducted a review of the literature to identify other cases of donor-derived coccidioidomycosis in solid organ transplant recipients and reviewed their clinical characteristics. Results. Fifteen prior cases of donor-derived coccidioidomycosis were identified. A majority of these cases were diagnosed by positive culture (83%). Mortality was high at 58%. Conclusions. Clinicians should maintain a high index of suspicion for disseminated coccidioidomycosis in patients who received transplants with organs from donors with a history of residing in endemic regions.
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Affiliation(s)
| | | | | | | | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine
| | - Michael Pham
- Department of Cardiovascular Medicine , Stanford University School of Medicine , California
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42
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Patellar Coccidioides immitis osteomyelitis: Case report and literature review. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000365] [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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Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract and includes both Crohn's disease and ulcerative colitis. Patients with IBD often present with abdominal pain, diarrhea, and rectal bleeding but may also have a wide variety of other symptoms such as weight loss, fever, nausea, vomiting, and possibly obstruction. Given that the presentation of IBD is not specific, the differential diagnosis is broad and encompasses a wide spectrum of diseases, many of which can mimic and/or even coexist with IBD. It is important for physicians to differentiate symptoms due to refractory IBD from symptoms due to IBD mimics when a patient is not responding to standard IBD treatment. Many of the various IBD mimics include infectious etiologies (viral, bacterial, mycobacterial, fungal, protozoal, and helminthic infections), vascular causes, other immune causes including autoimmune etiologies, drug-induced processes, radiation-induced, and other etiologies such as small intestinal bacterial overgrowth, diverticulitis, and bile acid malabsorption. Thoughtful consideration and evaluation of these potential etiologies through patient history and physical examination, as well as appropriate tests, endoscopic evaluation, and cross-sectional imaging is required to evaluate any patient presenting with symptoms consistent with IBD.
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45
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Mangold A, DiCaudo D, Blair J, Sekulic A. Chronic interstitial granulomatous dermatitis in coccidioidomycosis. Br J Dermatol 2016; 174:881-884. [DOI: 10.1111/bjd.14295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- A.R. Mangold
- Department of Dermatology; Mayo Clinic; 13400 E Shea Blvd Scottsdale AZ 85259 U.S.A
| | - D.J. DiCaudo
- Department of Dermatology; Mayo Clinic; 13400 E Shea Blvd Scottsdale AZ 85259 U.S.A
| | - J.E. Blair
- Divisions of Infectious Diseases and Transplantation Medicine; Mayo Clinic; 13400 E Shea Blvd Scottsdale AZ 85259 U.S.A
| | - A. Sekulic
- Department of Dermatology; Mayo Clinic; 13400 E Shea Blvd Scottsdale AZ 85259 U.S.A
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46
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Farber SA, Rubin AI, Micheletti RG. Disseminated coccidioidomycosis masquerading as a ruptured epidermal inclusion cyst in a healthy young adult from Philadelphia. Int J Dermatol 2015; 54:e441-2. [DOI: 10.1111/ijd.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sara A. Farber
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Adam I. Rubin
- Department of Dermatology; University of Pennsylvania; Philadelphia PA USA
| | - Robert G. Micheletti
- Department of Dermatology; Department of Medicine; University of Pennsylvania; Philadelphia PA USA
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47
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Berli JU, Campbell WN, Katz RD. Coccidioidomycosis causing osteomyelitis of the hand in an immunocompetent patient. Hand (N Y) 2015; 10:562-4. [PMID: 26330797 PMCID: PMC4551624 DOI: 10.1007/s11552-014-9696-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coccidioidomycosis osteomyelitis is a rare entity considered even more rare when identified in the immunocompetent patient. In non-endemic areas, the diagnosis of a fungus-causing osteomyelitis is often delayed or overlooked. This results in delayed or inappropriate treatment. We present the case of a 35-year-old immunocompetent male immigrant from India who was ultimately diagnosed as having Coccidioidomycosis immitis osteomyelitis of his ring finger metacarpal. His initial surgery included drainage and bacterial cultures only. When he failed to improve, he presented for a second opinion. The patient's origin and travel history coupled with the appearance of rapid bone destruction on plain radiographs prompted a second operation for tissue biopsy and culture for bacteria, fungus, and mycobacteria cultures. This case highlights the importance of a thorough clinical history in deriving an appropriate differential diagnosis prior to surgical intervention.
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Affiliation(s)
- Jens U. Berli
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
| | - Wayne N. Campbell
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
| | - Ryan D. Katz
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
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48
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Abstract
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient. Endotracheal intubation in pregnancy carries an increased risk, due to airway edema and rapid oxygen desaturation following apnea. Few data are available to direct prolonged mechanical ventilation in pregnancy. Chest wall compliance is reduced, perhaps permitting slightly higher airway pressures. Optimizing oxygenation is important, but data on the use of permissive hypercapnia are limited. Delivery of the fetus does not always improve maternal respiratory function, but should be considered if benefit to the fetus is anticipated.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
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49
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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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50
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Horng LM, Yaghoubian S, Ram A, Johnson R, Castro L, Kuo J, Deresinski S. Endocarditis due to Coccidioides spp: The Seventh Case. Open Forum Infect Dis 2015; 2:ofv086. [PMID: 26180835 PMCID: PMC4498286 DOI: 10.1093/ofid/ofv086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/03/2015] [Indexed: 11/18/2022] Open
Abstract
Coccidioides, a dimorphic fungus endemic within the Americas, primarily causes pulmonary disease but may disseminate. We describe a case of confirmed Coccidioides endocarditis, the seventh reported in literature. Coccidioides endocarditis often requires tissue diagnosis and combined surgical and medical treatment.
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Affiliation(s)
- Lily M Horng
- Department of Infectious Diseases and Geographic Medicine , Stanford University , California
| | | | - Arleen Ram
- Department of Internal Medicine , Eisenhower Medical Center , Rancho Mirage, California
| | - Royce Johnson
- Infectious Diseases , Kern Medical Center , Bakersfield, California ; David Geffen School of Medicine , University of California, Los Angeles
| | - Luis Castro
- Sequoia Heart and Vascular Institute , Redwood City, California
| | - Jenny Kuo
- Department of Pathology , Sequoia Hospital , Redwood City, California
| | - Stan Deresinski
- Department of Infectious Diseases and Geographic Medicine , Stanford University , California
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