Coccidioides immitis: two cases of misidentified mycosis

Primary cutaneous coccidioidomycosis: first imported case in north India

Coccidioidomycosis is a fungal disease found only in the Western Hemisphere. In recent years, the incidence of the disease has increased in California and Arizona, which may be partially due to the rapid immigration of previously unexposed persons from states outside the endemic areas. The disease in the nonendemic areas is usually imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis in these cases. Histopathological examination is the key to the diagnosis when fungal culture and molecular studies are not available. We hereby report an imported case of cutaneous coccidioidomycosis, which to the best of our knowledge is the first case report from North India.

First imported coccidioidomycosis in Turkey: A potential health risk for laboratory workers outside endemic areas

Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is endemic in arid climate zones in America, travel-related cases have been reported. We report the first documented case of coccidioidomycosis in Turkey, overviewing reported cases in Europe and underlying difficulties of differential diagnosis outside endemic regions. The patient was an otherwise healthy 41-year-old man who travelled endemic areas. Laboratory diagnosis was based on direct microscopy of two subsequent subcutaneous biopsy specimens and culture and confirmed molecularly. Laboratory personnel should become aware that BioSafety Level-3 organisms may become more frequent and widespread.

[Coccidioidomycosis presenting as a pulmonary nodule after pneumonia]

Coccidioidomycosis is a fungal infection endemic in the south west of the United States. Sixty percent of infected individuals remain asymptomatic. Symptomatic disease manifests itself with variable signs such as pneumonia, pleural effusion, empyema or acute respiratory distress syndrome. Residual disease includes pulmonary nodules and fibrosis. We report a case of a woman, returning from a trip to Arizona, presenting with an acute respiratory infection associated with erythema nodosum and arthralgia. She was successfully treated with routine antibiotics. The acute pneumonia resolved and the radiological infiltrate contract into a solitary pulmonary nodule. We suspected a malignant nodule in a previous smoker. The diagnosis of pulmonary Coccidioidomycosis was made after surgical resection. One year later, the patient is asymptomatic and well. This review focuses on the most common clinical manifestations, the diagnostic strategy and the treatment and management of pulmonary Coccidioidomycosis.

A case study of imported pulmonary coccidioidomycosis

Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically.

An atypical morphologic presentation of Coccidioides spp. in fine-needle aspiration of lung

Infection due to Coccidioides spp., a dimorphic fungal pathogen, usually presents as a chronic pulmonary disease, occasionally with pulmonary nodules. On cytology, large spherules filled with endospores are typically seen. We report an unusual case of coccidioidomycosis in a 39-year-old female from an area nonendemic for Coccidioides and without other known risk factors for infection. Fine-needle aspiration of the patient's cavitary lung lesion revealed Coccidioides spp., which demonstrated atypical delicate septate hyphal forms and chains of conidia, with none of the large spherules typical of Coccidioides spp. Atypical hyphal and other forms of Coccidioides spp. have been reported in several studies, primarily from biopsy or tissue resection specimens. However, this is the first case to our knowledge that the organism has presented solely as conidial and atypical hyphal forms in an aspirated specimen. Pathologists who are unfamiliar with this atypical hyphal formation may misdiagnose the organism as several different fungi, including Aspergillus spp. or Fusarium spp. It is important to differentiate among fungi, as antifungal treatments may vary. Cytologists should be aware of the diverse morphologies demonstrated by Coccidioides spp. and include this organism in their differential diagnosis, even in patients seemingly devoid of pertinent risk factors.