1
|
Siler AD, Jaffey JA, Jacobs C, Shumway K. Diagnostic Contribution of Bronchoalveolar Lavage Sampling and Fungal Culture in a Dog With Pulmonary Coccidioidomycosis. Top Companion Anim Med 2023; 52:100754. [PMID: 36538969 DOI: 10.1016/j.tcam.2022.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
A 7-year-old, male neutered, Miniature Australian Shepherd from Arizona was presented for evaluation of a 3-month history of progressive cough. Thoracic radiographs revealed a focal alveolar pulmonary pattern and suspected tracheobronchial lymph node enlargement. Serum anti-Coccidioides spp. IgM/IgG antibodies were not detected by agar gel immunodiffusion performed by 2 different reference commercial veterinary laboratories approximately 3.5 and 3.75 months after respiratory tract signs were first noted. The dog failed to respond to empiric therapy with a cough suppressant and various antibiotics. Tracheobronchoscopy and bronchoalveolar lavage (BAL) were subsequently performed and cytological examination of the BAL fluid identified marked neutrophilic inflammation characterized by mildly degenerate neutrophils and no infectious organisms. Bacterial cultures were negative but fungal cultures revealed growth of Coccidioides spp. Clinical signs improved shortly after initiation of fluconazole administration and the dog achieved long-term sustained clinical remission. Here, we provide a description of a dog with pulmonary coccidioidomycosis diagnosed with fungal culture of BAL fluid. Airway sampling with cytological examination and fungal culture should be considered in dogs with persistent respiratory related clinical signs, negative antibody serology, and that have lived in or traveled to endemic areas.
Collapse
Affiliation(s)
- Alexis D Siler
- Department of Primary Care, Midwestern University College of Veterinary Medicine, Glendale, AZ, USA
| | - Jared A Jaffey
- Department of Specialty Medicine, Midwestern University College of Veterinary Medicine, Glendale, AZ, USA.
| | - Casandra Jacobs
- Department of Internal Medicine, Desert Veterinary Medical Specialists, Peoria, AZ, USA
| | | |
Collapse
|
2
|
Ampel NM. Coccidioidomycosis: Changing Concepts and Knowledge Gaps. J Fungi (Basel) 2020; 6:jof6040354. [PMID: 33321746 PMCID: PMC7770576 DOI: 10.3390/jof6040354] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
Although first described more than 120 years ago, much remains unknown about coccidioidomycosis. In this review, new information that has led to changing concepts will be reviewed and remaining gaps in our knowledge will be discussed. In particular, new ideas regarding ecology and epidemiology, problems and promises of diagnosis, controversies over management, and the possibility of a vaccine will be covered.
Collapse
Affiliation(s)
- Neil M Ampel
- Department of Infectious Diseases, Medicine and Immunobiology University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Van Dyke MCC, Thompson GR, Galgiani JN, Barker BM. The Rise of Coccidioides: Forces Against the Dust Devil Unleashed. Front Immunol 2019; 10:2188. [PMID: 31572393 PMCID: PMC6749157 DOI: 10.3389/fimmu.2019.02188] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
Coccidioidomycosis (Valley fever) is a fungal disease caused by the inhalation of Coccidioides posadasii or C. immitis. This neglected disease occurs in the desert areas of the western United States, most notably in California and Arizona, where infections continue to rise. Clinically, coccidioidomycosis ranges from asymptomatic to severe pulmonary disease and can disseminate to the brain, skin, bones, and elsewhere. New estimates suggest as many as 350,000 new cases of coccidioidomycosis occur in the United States each year. Thus, there is an urgent need for the development of a vaccine and new therapeutic drugs against Coccidioides infection. In this review, we discuss the battle against Coccidioides including the development of potential vaccines, the quest for new therapeutic drugs, and our current understanding of the protective host immune response to Coccidioides infection.
Collapse
Affiliation(s)
| | - George R Thompson
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States
| | - John N Galgiani
- Valley Fever Center for Excellence, Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, United States
| | - Bridget M Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| |
Collapse
|
5
|
Blair JE, Ampel NM, Hoover SE. Coccidioidomycosis in selected immunosuppressed hosts. Med Mycol 2019; 57:S56-S63. [PMID: 29669037 DOI: 10.1093/mmy/myy019] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/08/2018] [Indexed: 12/23/2022] Open
Abstract
After contracting coccidioidomycosis, persons with impaired cellular immunity are more likely than healthy persons to have severe infection, disseminated infection, and higher mortality rates. In this brief review, we summarize the clinical manifestations, diagnosis, treatment, and prevention of coccidioidomycosis in persons infected with human immunodeficiency virus (HIV), recipients of solid organ or hematopoietic stem cell transplants, and recipients of biologic response modifiers. Among individuals infected with HIV, a diagnosis of acquired immunodeficiency syndrome (AIDS) and a CD4 T-lymphocyte count <250 cells/μl were associated with more severe coccidioidomycosis, whereas less severe disease occurred among those with undetectable HIV-RNA and higher CD4 T-lymphocyte counts, indicating that controlled HIV viremia and improved cellular immune status are important in limiting disease. For transplant recipients whose immunosuppression typically peaks in the first 3 to 6 months and tapers thereafter, the greatest risk of acute coccidioidomycosis occurs 6 to 12 months after transplantation. Relapses of recent coccidioidomycosis may occur during ongoing immunosuppression when patients are not taking suppressive antifungal medication. Recipients of biologic agents, especially those that impair tumor necrosis factor α (TNF-α), may be at increased risk for poorly controlled coccidioidomycosis; however, the best way to prevent and treat such infections has yet to be defined.
Collapse
Affiliation(s)
- Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Neil M Ampel
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA.,Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona, USA
| | - Susan E Hoover
- Division of Infectious Diseases, Sanford Health, Sioux Falls, South Dakota, USA
| |
Collapse
|
6
|
|
7
|
Kirkland TN. The Quest for a Vaccine Against Coccidioidomycosis: A Neglected Disease of the Americas. J Fungi (Basel) 2016; 2:E34. [PMID: 29376949 PMCID: PMC5715932 DOI: 10.3390/jof2040034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 12/04/2022] Open
Abstract
Coccidioidomycosis (Valley Fever) is a disease caused by inhalation of Coccidioides spp. This neglected disease has substantial public health impact despite its geographic restriction to desert areas of the southwestern U.S., Mexico, Central and South America. The incidence of this infection in California and Arizona has been increasing over the past fifteen years. Several large cities are within the endemic region in the U.S. Coccidioidomycosis accounts for 25,000 hospital admissions per year in California. While most cases of coccidioidomycosis resolve spontaneously, up to 40% are severe enough to require anti-fungal treatment, and a significant number disseminate beyond the lungs. Disseminated infection involving the meninges is fatal without appropriate treatment. Infection with Coccidioides spp. is protective against a second infection, so vaccination seems biologically plausible. This review of efforts to develop a vaccine against coccidioidomycosis focuses on vaccine approaches and the difficulties in identifying protein antigen/adjuvant combinations that protect in experimental mouse models. Although the quest for a vaccine is still in the early stage, scientific efforts for vaccine development may pave the way for future success.
Collapse
Affiliation(s)
- Theo N Kirkland
- Departments of Pathology and Medicine, University of California, San Diego, School of Medicine, San Diego, CA 92161, USA.
| |
Collapse
|
8
|
|
9
|
Differences in Host Innate Responses among Coccidioides Isolates in a Murine Model of Pulmonary Coccidioidomycosis. EUKARYOTIC CELL 2015; 14:1043-53. [PMID: 26275879 DOI: 10.1128/ec.00122-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 01/18/2023]
Abstract
Coccidioides immitis and Coccidioides posadasii are soil-dwelling fungi and the causative agents of coccidioidomycosis, a mycosis endemic to certain semiarid regions in the Americas. The most common route of infection is by inhalation of airborne Coccidioides arthroconidia. Once a susceptible host inhales the conidia, a transition to mature endosporulated spherules can occur within the first 5 days of infection. For this study, we examined the host response in a murine model of coccidioidomycosis during a time period of infection that has not been well characterized. We collected lung tissue and bronchoalveolar lavage fluid (BALF) from BALB/c mice that were infected with a C. immitis pure strain, a C. immitis hybrid strain, or a C. posadasii strain as well as uninfected mice. We compared the host responses to the Coccidioides strains used in this study by assessing the level of transcription of selected cytokine genes in lung tissues and characterized host and fungal proteins present in BALF. Host response varied depending on the Coccidioides strain that was used and did not appear to be overly robust. This study provides a foundation to begin to dissect the host immune response early in infection, to detect abundant Coccidioides proteins, and to develop diagnostics that target these early time points of infection.
Collapse
|
10
|
Cytokine Profiles from Antigen-Stimulated Whole-Blood Samples among Patients with Pulmonary or Nonmeningeal Disseminated Coccidioidomycosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:917-22. [PMID: 26041038 DOI: 10.1128/cvi.00280-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/28/2015] [Indexed: 12/14/2022]
Abstract
The outcome of coccidioidomycosis depends on a robust specific cellular immune response. A T-helper type 1 (Th1) cellular immune response has been previously associated with resolution of clinical illness. However, the precise elements of this response and whether cytokines not involved with the Th1 response play a role in coccidioidomycosis are not known. Whole-blood samples were obtained from subjects with active coccidioidomycosis and controls and incubated for 18 h with T27K, a coccidioidal antigen preparation. The supernatant was then assayed for gamma interferon (IFN-γ), interleukin-2 (IL-2), tumor necrosis factor alpha (TNF-α), IL-4, IL-6, IL-10, and IL-17A. A total of 43 subjects, 16 with acute pneumonia, 9 with pulmonary sequelae of nodules and cavities, and 18 with nonmeningeal disseminated coccidioidomycosis, were studied. Compared to concentrations in healthy immune and nonimmune donors, the median concentration of IL-17A was significantly higher in those with active coccidioidomycosis (for both, P < 0.01). In addition, IL-6 concentrations were higher while IL-2 and IFN-γ concentrations were significantly lower in those with nonmeningeal disseminated disease diagnosed within 12 months than in those with acute pneumonia (for all, P < 0.05). The cytokine profile among patients with active coccidioidomycosis is distinct in that IL-17A is persistently present. In addition, those with nonmeningeal disseminated disease have an increased inflammatory cytokine response and diminished Th1 responses that modulate over time.
Collapse
|
11
|
Affiliation(s)
- Eric R. G. Lewis
- Pathogen Genomics Division, Translational Genomics Institute, Flagstaff, Arizona, United States of America
- Northern Arizona Center for Valley Fever Research, Translational Genomics Institute, Flagstaff, Arizona, United States of America
- * E-mail: (ERGL); (JRB); (BMB)
| | - Jolene R. Bowers
- Pathogen Genomics Division, Translational Genomics Institute, Flagstaff, Arizona, United States of America
- * E-mail: (ERGL); (JRB); (BMB)
| | - Bridget M. Barker
- Pathogen Genomics Division, Translational Genomics Institute, Flagstaff, Arizona, United States of America
- Northern Arizona Center for Valley Fever Research, Translational Genomics Institute, Flagstaff, Arizona, United States of America
- Center for Microbial Genetic and Genomics, Department of Biology, Northern Arizona University, Flagstaff, Arizona, United States of America
- * E-mail: (ERGL); (JRB); (BMB)
| |
Collapse
|
12
|
Johnson L, Gaab EM, Sanchez J, Bui PQ, Nobile CJ, Hoyer KK, Peterson MW, Ojcius DM. Valley fever: danger lurking in a dust cloud. Microbes Infect 2014; 16:591-600. [PMID: 25038397 DOI: 10.1016/j.micinf.2014.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 12/01/2022]
Abstract
Coccidioides immitis and Coccidioides posadasii contribute to the development of Valley Fever. The ability of these fungal pathogens to evade the host immune system creates difficulty in recognition and treatment of this debilitating infection. In this review, we describe the current knowledge of Valley Fever and approaches to improve prevention, detection, and treatment.
Collapse
Affiliation(s)
- Larry Johnson
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Erin M Gaab
- Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Javier Sanchez
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Phuong Q Bui
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Clarissa J Nobile
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Katrina K Hoyer
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Michael W Peterson
- Department of Internal Medicine, University of California San Francisco - Fresno, Fresno, CA 93703, USA
| | - David M Ojcius
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA.
| |
Collapse
|
13
|
|