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Román-Montes CM, Seoane-Hernández L, Flores-Miranda R, Tello-Mercado AC, Rangel-Cordero A, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A, González-Lara F. Coccidioidomycosis in Immunocompromised at a Non-Endemic Referral Center in Mexico. J Fungi (Basel) 2024; 10:429. [PMID: 38921414 PMCID: PMC11205067 DOI: 10.3390/jof10060429] [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: 04/26/2024] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.
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Affiliation(s)
- Carla M. Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - Lisset Seoane-Hernández
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Rommel Flores-Miranda
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Andrea Carolina Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - Rosa Areli Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Fernanda González-Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
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Reihani AR, Jayakumar N, Searcy R, Vu AN, Perumbeti A, Thomas J. Unique presentation of an endemic opportunistic fungal infection: Disseminated coccidioidomycosis mimicking metastatic lung cancer with endotracheal and endobronchial involvement. Respir Med Case Rep 2024; 49:102000. [PMID: 38576860 PMCID: PMC10990736 DOI: 10.1016/j.rmcr.2024.102000] [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: 07/14/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Coccidioidomycosis is a fungal infection primarily Endemic in the Southwest United States. Disseminated Coccidioidomycosis is a life-threatening variant that mainly occurs in an immunocompromised host. This report describes an unusual presentation of disseminated Coccidioidomycosis in an immunocompetent individual. The patient was admitted with a subacute cough, progressively worsening shortness of breath, significant weight loss, nodular skin lesions in upper extremities, and acute hypoxemic respiratory failure. Chest imaging revealed extensive nodularity and mass-like lesions. What sets this case apart is the significant endotracheal and endobronchial involvement, which mimicked metastatic lung cancer. The diagnosis was confirmed through serology and bronchoscopy biopsy. This case underscores the critical importance of considering detailed travel history and maintaining a high index of suspicion for fungal infections in patients with endobronchial lesions, particularly in regions where Coccidioidomycosis is endemic.
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Affiliation(s)
- Amir R. Reihani
- Pulmonology Fellowship, Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Naveen Jayakumar
- Department of Pulmonology and Critical Care, Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Ricardo Searcy
- Internal Medicine Department, Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Anderson N. Vu
- Internal Medicine Department, Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Anil Perumbeti
- Department of Pulmonology and Critical Care, Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Justin Thomas
- Department of Pulmonology and Critical Care, Eisenhower Medical Center, Rancho Mirage, California, USA
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, California, USA
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3
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Campuzano A, Pentakota KD, Liao YR, Zhang H, Wiederhold NP, Ostroff GR, Hung CY. A Recombinant Multivalent Vaccine (rCpa1) Induces Protection for C57BL/6 and HLA Transgenic Mice against Pulmonary Infection with Both Species of Coccidioides. Vaccines (Basel) 2024; 12:67. [PMID: 38250880 PMCID: PMC10819930 DOI: 10.3390/vaccines12010067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Coccidioidomycosis is caused by Coccidioides posadasii (Cp) and Coccidioides immitis (Ci), which have a 4-5% difference in their genomic sequences. There is an urgent need to develop a human vaccine against both species. A previously created recombinant antigen (rCpa1) that contains multiple peptides derived from Cp isolate C735 is protective against the autologous isolate. The focus of this study is to evaluate cross-protective efficacy and immune correlates by the rCpa1-based vaccine against both species of Coccidioides. DNA sequence analyses of the homologous genes for the rCpa1 antigen were conducted for 39 and 17 clinical isolates of Cp and Ci, respectively. Protective efficacy and vaccine-induced immunity were evaluated for both C57BL/6 and human HLA-DR4 transgenic mice against five highly virulent isolates of Cp and Ci. There are total of seven amino acid substitutions in the rCpa1 antigen between Cp and Ci. Both C57BL/6 and HLA-DR4 mice that were vaccinated with an rCpa1 vaccine had a significant reduction of fungal burden and increased numbers of IFN-γ- and IL-17-producing CD4+ T cells in the first 2 weeks post challenge. These data suggest that rCpa1 has cross-protection activity against Cp and Ci pulmonary infection through activation of early Th1 and Th17 responses.
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Affiliation(s)
- Althea Campuzano
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Komali Devi Pentakota
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Yu-Rou Liao
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Hao Zhang
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Nathan P. Wiederhold
- Department of Pathology, Graduate School of Biomedical Sciences, UT Health, San Antonio, TX 78229, USA;
| | - Gary R. Ostroff
- Program in Molecular Medicine, UMass Chan Medical School, Worcester, MA 01655, USA;
| | - Chiung-Yu Hung
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
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Reyes-Montes MDR, León-García AA, Frías-De-León MG, Acosta-Altamirano G, Sánchez-Saavedra EP, Victoriano-Pastelín I, Meraz-Ríos B, Duarte-Escalante E. Clinical Cases of Coccidioidomycosis in the Americas in the Period 1950-2021: Epidemiology Data, Diagnosis, and Treatment. Life (Basel) 2023; 13:2109. [PMID: 38004249 PMCID: PMC10672650 DOI: 10.3390/life13112109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Coccidioidomycosis, caused by Coccidioides immitis and C. posadasii, causes significant morbidity and mortality, both in immunocompetent and immunocompromised people, mainly in endemic areas. The present work analyzed its epidemiology, diagnostic methods, and treatment by reviewing clinical cases published from 1950 to 2021. Fifty-nine articles were included, corresponding to 275 clinical cases. The results showed a higher incidence of coccidioidomycosis in the male gender than the female gender. The most affected age group was 31-40 years, and the most reported clinical presentation was disseminated with greater involvement in cutaneous and subcutaneous tissue, followed by the CNS, bone system, and peritoneum. The species most frequently reported was C. immitis. The most used treatment was azoles, followed by their combination with amphotericin B, monotherapy with amphotericin B, and alternative medicine. This work shows that epidemiological data outside the USA are still scarce. Serological tests are the preferred diagnostic method in daily medical practice, and cultures remain the gold standard. The treatment for coccidioidomycosis is ketoconazole and amphotericin B, individually or in combination.
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Affiliation(s)
- María del Rocío Reyes-Montes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Adriana Anel León-García
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - María Guadalupe Frías-De-León
- Hospital Regional de Alta Especialidad de Ixtapaluca, Unidad de Investigación Biomédica, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (G.A.-A.)
| | - Gustavo Acosta-Altamirano
- Hospital Regional de Alta Especialidad de Ixtapaluca, Unidad de Investigación Biomédica, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (G.A.-A.)
| | - Erika Paola Sánchez-Saavedra
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Isai Victoriano-Pastelín
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Beatriz Meraz-Ríos
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Ciudad de Mexico 04510, Mexico; (M.d.R.R.-M.); (A.A.L.-G.); (E.P.S.-S.); (I.V.-P.); (B.M.-R.)
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Monroy-Nieto J, Gade L, Benedict K, Etienne KA, Litvintseva AP, Bowers JR, Engelthaler DM, Chow NA. Genomic Epidemiology Linking Nonendemic Coccidioidomycosis to Travel. Emerg Infect Dis 2023; 29:110-117. [PMID: 36573555 PMCID: PMC9796224 DOI: 10.3201/eid2901.220771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Coccidioidomycosis is a fungal infection endemic to hot, arid regions of the western United States, northern Mexico, and parts of Central and South America. Sporadic cases outside these regions are likely travel-associated; alternatively, an infection could be acquired in as-yet unidentified newly endemic locales. A previous study of cases in nonendemic regions with patient self-reported travel history suggested that infections were acquired during travel to endemic regions. We sequenced 19 Coccidioides isolates from patients with known travel histories from that earlier investigation and performed phylogenetic analysis to identify the locations of potential source populations. Our results show that those isolates were phylogenetically linked to Coccidioides subpopulations naturally occurring in 1 of the reported travel locales, confirming that these cases were likely acquired during travel to endemic regions. Our findings demonstrate that genomic analysis is a useful tool for investigating travel-related coccidioidomycosis.
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Abe T, Yamaguchi F, Sakakura S, Shiratori Y, Mase A, Funaki T, Kamio Y, Suzuki T, Shikama Y, Hoshino Y. Surgical Resection to Treat a Japanese Patient with Pulmonary Coccidioidomycosis. Infect Drug Resist 2023; 16:2787-2791. [PMID: 37187484 PMCID: PMC10178290 DOI: 10.2147/idr.s401752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Coccidioidomycosis is an endemic disease that is particularly prevalent in the United States. However, its geographic distribution is becoming widespread. Here, we present a Japanese male who resided in the United States for 1 year, where he was diagnosed with pulmonary coccidioidomycosis that was accompanied by cavity formation. He did not tolerate antifungal therapy and consequently underwent partial resection of the upper lobe of his left lung upon his return to Japan. The patient's symptoms improved after surgery. The trend toward global networking and logistics means that a diagnosis of coccidioidomycosis should be considered in routine practice in nonendemic areas. Due to the rarity of surgical treatment for this disease, prolonged follow-up is necessary. During the last follow-up, the patient was symptom-free.
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Affiliation(s)
- Takashi Abe
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Correspondence: Fumihiro Yamaguchi, Department of Respiratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan, Tel +81-45-971-1151, Email
| | - Shunsuke Sakakura
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yo Shiratori
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ayaka Mase
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Toshitaka Funaki
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshito Kamio
- Departments of Thoracic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takashi Suzuki
- Departments of Thoracic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yusuke Shikama
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yasutaka Hoshino
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
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Important Mycosis of Wildlife: Emphasis on Etiology, Epidemiology, Diagnosis, and Pathology—A Review: PART 2. Animals (Basel) 2022; 12:ani12151897. [PMID: 35892547 PMCID: PMC9332861 DOI: 10.3390/ani12151897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Wild animals are an important component of the ecosystem, and play a major role in it. However, in recent years, there has been an astronomical increase in the incidence of wildlife mycotic diseases leading to wildlife extermination. It is important to note that most of these mycotic diseases are zoonotic, and since there is a lot of attention given to zoonosis of a bacterial or viral origin in recent times, it is important to look into the mycotic diseases which may have zoonotic potential. Previously, the authors expatiated on some major wildlife mycotic diseases. In this review, we shed light on the etiology, epidemiology, diagnosis, pathogenesis, pathogenicity, macroscopic and microscopic pathology, and hematological and serum biochemical findings of dermatophytosis, coccidioidomycosis, blastomycosis, and sporotrichosis, which are very important mycoses of wildlife.
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Abstract
Coccidioidomycosis, colloquially known as Valley Fever, is an invasive dimorphic fungal infection caused by Coccidioides immitis and C. posadasii. The fungi are found in the arid desert soils of the southwestern US, as well as in parts of Mexico and Central and South America. Acquisition is typically via inhalation of arthroconidia which become airborne after both natural (e.g., earthquakes, dust storms, and fires) and human-related events (e.g., military maneuvers, recreational activities, agriculture, and construction). The incidence of infection in increasing likely a result of both climatic and populational changes. Further, the recognized geographic distribution of Coccidioides spp. is expanding, as cases are being diagnosed in new areas (e.g., eastern Washington, Oregon, and Utah). Most coccidioidal infections are asymptomatic (60%); however, approximately one-third develop a pulmonary illness which is a leading cause of community-acquired pneumonia in highly endemic areas. Uncommonly (0.5–2% of cases), the infection disseminates to extrapulmonary locations (e.g., skin, bones/joints, and the central nervous system), and is most commonly seen among persons with cellular immunodeficiencies (e.g., transplant recipients, HIV, and pregnancy) and non-Caucasian races (especially African Americans and Filipinos). The diagnosis of coccidioidomycosis requires astute clinical suspicion and laboratory findings, including positive serology, cultures, and/or histopathology results. Treatment is warranted among persons with pneumonia who have risk factors for complicated disease and among those with extrapulmonary disease. Novel antifungals with improved fungicidal activity and rapidity of action with fewer side effects and drug interactions are needed. Preventive strategies (e.g., education regarding the disease, dust avoidance, mask wearing, including among select groups, antifungal prophylaxis, and surveillance laboratory testing) are advised for residents and travelers to endemic areas. Currently, no preventive vaccine is available. Coccidioidomycosis has been recognized for over a century, and an expanding wealth of knowledge has been gained regarding this emerging infectious disease which will be reviewed here.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Department, Scripps Health System, San Diego, CA, USA.
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Comrie AC. No Consistent Link Between Dust Storms and Valley Fever (Coccidioidomycosis). GEOHEALTH 2021; 5:e2021GH000504. [PMID: 34877441 PMCID: PMC8628988 DOI: 10.1029/2021gh000504] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 05/04/2023]
Abstract
Dust storms, such as those associated with haboobs and strong regional winds, are frequently assumed to cause increases in cases of Valley fever (coccidioidomycosis). The disease is caused by inhaling arthroconidia of Coccidioides fungi that, after being disturbed from semi-desert subsoil, have become airborne. Fungal arthroconidia can be transported in low-wind conditions as well as in individual dust events, but there is no reliable evidence that all or most dust storms consistently lead to subsequent increases in coccidioidomycosis cases. Following a review of the relevant literature, this study examines the relationship between dust storms and coccidioidomycosis cases to determine if there is a consistent and general association between them. All recorded dust storms from 2006 to 2020 in and near the Phoenix area of Maricopa County, Arizona and the Bakersfield area of Kern County, California were used in a compositing analysis (superposed epoch analysis) of subsequent coccidioidomycosis cases in each area. Analyses of monthly and weekly disease case data showed no statistical differences in the patterns of coccidioidomycosis cases following dust storms versus non-dust storm conditions, for the entire data set as well as for seasonal subsets of the data. This study thoroughly analyzes post-dust storm coccidioidomycosis cases for a large set of dust storms, and it confirms and expands upon previous literature, including a recent study that measured airborne arthroconidia and found no consistent links connecting wind and dust conditions to increases in coccidioidomycosis.
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Ward RA, Thompson GR, Villani AC, Li B, Mansour MK, Wuethrich M, Tam JM, Klein BS, Vyas JM. The Known Unknowns of the Immune Response to Coccidioides. J Fungi (Basel) 2021; 7:jof7050377. [PMID: 34065016 PMCID: PMC8151481 DOI: 10.3390/jof7050377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022] Open
Abstract
Coccidioidomycosis, otherwise known as Valley Fever, is caused by the dimorphic fungi Coccidioides immitis and C. posadasii. While most clinical cases present with self-limiting pulmonary infection, dissemination of Coccidioides spp. results in prolonged treatment and portends higher mortality rates. While the structure, genome, and niches for Coccidioides have provided some insight into the pathogenesis of disease, the underlying immunological mechanisms of clearance or inability to contain the infection in the lung are poorly understood. This review focuses on the known innate and adaptive immune responses to Coccidioides and highlights three important areas of uncertainty and potential approaches to address them. Closing these gaps in knowledge may enable new preventative and therapeutic strategies to be pursued.
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Affiliation(s)
- Rebecca A. Ward
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (R.A.W.); (M.K.M.)
| | - George R. Thompson
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA 96817, USA;
| | - Alexandra-Chloé Villani
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (A.-C.V.); (B.L.)
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Harvard Medical School, Boston, MA 02115, USA;
| | - Bo Li
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (A.-C.V.); (B.L.)
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Harvard Medical School, Boston, MA 02115, USA;
| | - Michael K. Mansour
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (R.A.W.); (M.K.M.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Marcel Wuethrich
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA; (M.W.); (B.S.K.)
| | - Jenny M. Tam
- Harvard Medical School, Boston, MA 02115, USA;
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Bruce S. Klein
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA; (M.W.); (B.S.K.)
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jatin M. Vyas
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (R.A.W.); (M.K.M.)
- Harvard Medical School, Boston, MA 02115, USA;
- Correspondence: ; Tel.: +1-617-643-6444
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