Coccidioidomycosis

  • D. A. Bronnimann
  • J. N. Galgiani
Current Topic: Review

Abstract

Coccidioidomycosis is a largely self-limited fungal respiratory illness. However, the infrequent case of progressive or disseminated disease can be devastating. As international travel to and from endemic areas increases, physicians unfamiliar with the disease may be called upon to recognize and treat serious coccidioidal infections. The major risk factors for dissemination are race and immunosuppression. The most common sites of dissemination are the skin, lymph nodes, bone and meninges. Diagnosis is aided by investigation of the patient's clinical history, delayed-type hypersensitivity skin test reaction, serologic testing, and recovery of organisms from infected tissue or secretions for direct examination and culture. Fungicidal agents are not available, fortunately, fungistatic therapy allows many patients to recover. The availability of both intravenous/intrathecal and oral agents now allows more therapeutic flexibility in the treatment of this disease.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Steele, T., Kaminski, G. A case of coccidioidomycosis in Australia. Medical Journal of Australia 1977, 1: 968–969.PubMedGoogle Scholar
  2. 2.
    Schildge, J., Kaiser, D., Wolfart, W. Kokzidioidomykose in Deutschland — Problematik der klinischen und histologischen Diagnosestellung anhand eines Fallbeispieles. Praxis und Klinik der Pneumologie 1983, 37: 1065–1068.PubMedGoogle Scholar
  3. 3.
    Cavin, R., Rosenspies, U., Jayet, A. Aspergillomes, actinomycoses, nocardiose, coccidioidomycose et bilharziose pulmonaires: a propos de 19 cas. Helvetica Chirurgica Acta 1984, 51: 251–256.PubMedGoogle Scholar
  4. 4.
    Werner, S. B., Pappagianis, D., Heindl, I., Mickel, A. An epidemic of coccidioidomycosis among archeology students in northern California. New England Journal of Medicine 1972, 286: 507–512.PubMedGoogle Scholar
  5. 5.
    Williams, P. L., Sable, D. L., Mendez, P., Smyth, L. T. Symptomatic coccidioidomycosis following a severe natural dust storm: an outbreak at the Naval Air Station, Lemoore, California. Chest 1979, 76: 566–570.PubMedGoogle Scholar
  6. 6.
    Gehlbach, S. H., Hamilton, J. D., Conant, N. F. Coccidioidomycosis: an occupational disease in cotton mill workers. Archives of Internal Medicine 1973, 131: 254–255.PubMedGoogle Scholar
  7. 7.
    Levan, N. E., Huntington, R. W. Primary cutaneous coccidioidomycosis in agricultural workers. Archives of Dermatology 1965, 92: 215–220.Google Scholar
  8. 8.
    Winn, W. A. Primary cutaneous coccidioidomycosis. Archives of Dermatology 1965, 92: 221–228.Google Scholar
  9. 9.
    O'Brien, J. J., Gilsdorf, J. R. Primary cutaneous coccidioidomycosis in childhood. Pediatric Infectious Disease 1986, 5: 485–486.PubMedGoogle Scholar
  10. 10.
    Johnson, J. E., Perry, J. E., Fekety, F. R., Kadull, P. J., Cluff, L. E. Laboratory-acquired coccidioidomycosis: a report of 210 cases. Annals of Internal Medicine 1964, 60: 941–956.Google Scholar
  11. 11.
    Winn, W. R., Finegold, S. M., Huntington, R. W. Coccidioidomycosis with fungemia. In: Ajello, L. (ed.): Coccidioidomycosis. University of Arizona Press, Tucson, AZ, 1967, p. 93–109.Google Scholar
  12. 12.
    Graham, A. R., Sobonya, R. E., Bronnimann, D. A., Galgiani, J. N. Quantitative pathology of coccidioidomycosis in acquired immunodeficiency syndrome. Human Pathology 1988, 19: 800–806.PubMedGoogle Scholar
  13. 13.
    Willett, F. M., Weiss, A. Coccidioidomycosis in southern California: report of a new endemic area with a review of 100 cases. Annals of Internal Medicine 1945, 23: 349–375.Google Scholar
  14. 14.
    Yozwiak, M. L., Lundergan, L. L., Kerrick, S. S., Galgiani, J. N. Symptoms and routine laboratory abnormalities associated with coccidioidomycosis. Western Journal of Medicine 1988, 149: 419–421.PubMedGoogle Scholar
  15. 15.
    Harvey, W. C., Greendyke, W. H. Skin lesions in acute coccidioidomycosis. American Family Physician 1970, 2: 81–85.Google Scholar
  16. 16.
    Smith, C. E. Epidemiology of acute coccidioidomycosis with erythema nodosum (“San Joaquin” or “Valley Fever”). American Journal of Public Health 1940, 30: 600–611.Google Scholar
  17. 17.
    Jamison, H. W. A roentgen study of chronic pulmonary coccidioidomycosis. American Journal of Roentgenology and Radium Therapy 1946, 55: 396–412.Google Scholar
  18. 18.
    Lonky, S. A., Catanzaro, A., Moser, K. M., Einstein, H. Acute coccidioidal pleural effusion. American Review of Respiratory Disease 1976, 114: 681–688.PubMedGoogle Scholar
  19. 19.
    Larsen, R. A., Jacobson, J. A., Morris, A. H., Benowitz, B. A. Acute respiratory failure caused by primary pulmonary coccidioidomycosis: two case reports and a review of the literature. American Review of Respiratory Disease 1985, 131: 797–799.PubMedGoogle Scholar
  20. 20.
    Rowland, V. S., Westfall, R. E., Hinchcliffe, W. A., Jarrett, P. B.: Acute respiratory failure in miliary cocciodioidomycosis. In: Ajello, L. (ed.): Coccidioidomycosis — current clinical and diagnostic status. Symposia Specialists, Miami, 1977, p. 139–155.Google Scholar
  21. 21.
    Bronnimann, D. A., Adam, R. D., Galgiani, J. N., Habib, M. P., Petersen, E. A., Porter, B., Bloom, J. W. Coccidioidomycosis in the acquired immunodeficiency syndrome. Annals of Internal Medicine 1987, 106: 372–379.PubMedGoogle Scholar
  22. 22.
    Cohen, I. M., Galgiani, J. N., Potter, D., Ogden, D. A. Coccidioidomycosis in renal replacement therapy. Archives of Internal Medicine 1982, 142: 489–494.PubMedGoogle Scholar
  23. 23.
    Seltzer, J., Broaddus, V. C., Jacobs, R., Golden, J. A. Reactivation of coccidioides infection. Western Journal of Medicine 1986, 145: 96–98.PubMedGoogle Scholar
  24. 24.
    Deresinski, S. C., Stevens, D. A. Coccidioidomycosis in compromised hosts: experience at Stanford University Hospital. Medicine 1975, 54: 377–395.PubMedGoogle Scholar
  25. 25.
    Bayer, A. S. Fungal pneumonias; pulmonary coccidioidal syndromes (Part 1). Primary and progressive primary coccidioidal pneumonias-diagnostic, therapeutic, and prognostic considerations. Chest 1981, 79: 575–583.PubMedGoogle Scholar
  26. 26.
    Drutz, D. J., Cantanzaro, A. Coccidioidomycosis. Part II. American Review of Respiratory Disease 1978, 117: 727–771.PubMedGoogle Scholar
  27. 27.
    Bouza, E., Dreyer, J. S., Hewitt, W. L., Meyer, R. D. Coccidioidal meningitis. Medicine 1981, 60: 139–172.PubMedGoogle Scholar
  28. 28.
    Bloom, J. W., Camilli, A. E., Barbee, R. A. Disseminated coccidioidomycosis: a ten-year experience. In: Einstein, H. E., Cantanzaro, A. (ed.): Coccidioidomycosis. The National Foundation for Infectious Diseases, Washington, D.C., 1985, p. 369–378.Google Scholar
  29. 29.
    Gillespie, R. Treatment of cranial osteomyelitis from disseminated coccidioidomycosis. Western Journal of Medicine 1986, 145: 694–697.PubMedGoogle Scholar
  30. 30.
    Johnson, W. M. Racial factors in coccidioidomycosis: mortality experience in Arizona: a review of the literature. Arizona Medicine 1982, 39: 18–24.PubMedGoogle Scholar
  31. 31.
    Deresinski, S. C., Pappagianis, D., Stevens, D. A. Association of ABO blood group and outcome of coccidioidal infection. Sabouraudia 1979, 17: 261–264.PubMedGoogle Scholar
  32. 32.
    Cantanzaro, A. Pulmonary mycosis in pregnant women. Chest 1984, 86, Supplement 3: 14–18.PubMedGoogle Scholar
  33. 33.
    Wack, E. E., Ampel, N. M., Galgiani, J. N., Bronnimann, D. A. Coccidioidomycosis during pregnancy: an analysis of ten cases among 47, 120 pregnancies. Chest 1988, 94: 376–379.PubMedGoogle Scholar
  34. 34.
    Boddicker, J. H., Fong, D., Walsh, T. E., Schillaci, R. F., Moniot, A. L., Catanzaro, A. Bone and gallium scanning in the evaluation of disseminated coccidioidomycosis. American Review of Respiratory Disease 1980, 122: 279–287.PubMedGoogle Scholar
  35. 35.
    McGahan, J. P., Graves, D. S., Palmer, P. E. S., Stadalnik, R. C., Dublin, A. B. Classic and contemporary imaging of coccidioidomycosis. American Journal of Roentgenology 1981, 136: 393–404.PubMedGoogle Scholar
  36. 36.
    Sobel, R. A., Ellis, W. G., Nielsen, S. L., Davis, R. L. Central nervous system coccidioidomycosis: a clinicopathologic study of treatment with and without amphotericin B. Human Pathology 1984, 15: 980–995.PubMedGoogle Scholar
  37. 37.
    Cox, R. A., Vivas, J. R. Spectrum of in vivo and in vitro cell-mediated immune responses in coccidioidomycosis. Cellular Immunology 1977, 31: 130–141.PubMedGoogle Scholar
  38. 38.
    Smith, C. E., Saito, M. T., Beard, R. R., Kepp, R. M., Clark, R. W., Eddie, B. U. Serological tests in the diagnosis and prognosis of coccidioidomycosis. American Journal of Hygiene 1950, 52: 1–21.PubMedGoogle Scholar
  39. 39.
    Galgiani, J. N. Development of dermal hypersensitivity to coccidioidal antigens associated with repeated skin testing. American Review of Respiratory Disease 1986, 134: 1045–1047.PubMedGoogle Scholar
  40. 40.
    Dodge, R. R., Lebowitz, M. D., Barbee, R., Burrows, B. Estimates ofCoccidioides immitis infection by skin test reactivity in an endemic community. American Journal of Public Health 1985, 75: 863–865.PubMedGoogle Scholar
  41. 41.
    Woodruff III, W. W., Buckley III, C. E., Gallis, H. A., Cohn, J. R., Wheat, R. W. Reactivity to spherule-derived coccidioidin in the southeastern United States. Infection and Immunity 1984, 43. 860–869.PubMedGoogle Scholar
  42. 42.
    Drutz, D. J., Cantanzaro, A. Coccidioidomycosis. Part I. American Review of Respiratory Disease 1978, 117: 559–585.PubMedGoogle Scholar
  43. 43.
    Lebowitz, M. D., Johnson, W. M., Kaltenborn, W. Coccidioidin skin test reactivity and cross-reactivity with histoplasmin in a Tucson population. In: Ajello, L. (ed.): Coccidioidomycosis: current clinical and diagnostic status. Symposia Specialists Press, Miami, 1977, p. 45–61.Google Scholar
  44. 44.
    Catanzaro, A. Pulmonary coccidioidomycosis. Medical Clinics of North America 1980, 64: 461–473.PubMedGoogle Scholar
  45. 45.
    Huppert, M., Bailey, J. W. The use of immunodiffusion tests in coccidioidomycosis. II. An immunodiffusion test as a substitute for the tube precipitin test. American Journal of Clinical Pathology 1965, 35: 369–373.Google Scholar
  46. 46.
    Huppert, M., Bailey, J. W. The use of immunodiffusion tests in coccidioidomycosis. I. The accuracy and reproducibility of the immunodiffusion test which correlates with complement fixation. American Journal of Clinical Pathology 1965, 35: 364–368.Google Scholar
  47. 47.
    Wieden, M. A., Galgiani, J. N., Pappagianis, D. Comparison of immunodiffusion techniques with standard complement fixation assay for quantitation of coccidioidal antibodies. Journal of Clinical Microbiology 1983, 18: 529–534.PubMedGoogle Scholar
  48. 48.
    Smithline, N., Ogden, D. A., Cohn, A. I., Johnson, K. Disseminated coccidioidomycosis in renal transplant patients. In: Ajello, L. (ed.): Coccidioidomycosis: current clinical and diagnostic status. Symposia Specialists Press, Miami, 1977, p. 201–206.Google Scholar
  49. 49.
    Lundergan, L. L., Kerrick, S. S., Galgiani, J. N. Coccidioidomycosis at a university outpatient clinic: a clinical description. In: Einstein, H. E., Cantanzaro, A. (ed.): Coccidioidomycosis. The National Foundation for Infectious Diseases, Washington, D.C., 1985, p. 47–54.Google Scholar
  50. 50.
    Kaufman, L., Standard, P. G. Specific and rapid identification of medically important fungi by exoantigen detection. Annual Review of Microbiology 1987, 41: 209–225.PubMedGoogle Scholar
  51. 51.
    Warlick, M. A., Quan, S. F., Sobonya, R. E. Rapid diagnosis of pulmonary coccidioidomycosis. Archives of Internal Medicine 1983, 143: 723–725.PubMedGoogle Scholar
  52. 52.
    Spebar, M. J., Jarstfer, B. S., Zeigler, M. G. Operative management of chronic coccidioidomycosis. American Journal of Surgery 1977, 134: 777–779.PubMedGoogle Scholar
  53. 53.
    Salomon, N. W., Osborne, R., Copeland, J. G. Surgical manifestations and results of treatment of pulmonary coccidioidomycosis. Annals of Thoracic Surgery 1980, 30: 433–438.PubMedGoogle Scholar
  54. 54.
    Forseth, J., Rohwedder, J. J., Levine, B. E., Saubolle, M. A. Experience with needle biopsy for coccidioidal lung nodules. Archives of Internal Medicine 1986, 146: 319–320.PubMedGoogle Scholar
  55. 55.
    Wallace, J. M., Catanzaro, A., Moser, K. M., Harrell, J. H. Flexible fiberoptic bronchoscopy for diagnosing pulmonary coccidioidomycosis. American Review of Respiratory Disease 1981, 123: 286–290.PubMedGoogle Scholar
  56. 56.
    Broaddus, C., Dake, M. D., Stulbarg, M. S., Blumenfeld, W., Hadley, W. K., Golden, J. A., Hopewell, P. C. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Annals of Internal Medicine 1985, 102: 747–752.PubMedGoogle Scholar
  57. 57.
    Sobonya, R. E., Wiens, J., Trego, D., Barbee, R. A. Detection of coccidioidomycosis, pneumocystis, and viruses in the desert southwest by bronchoalveolar lavage with “rapid pap” preparations. Chest 1988, 94, Supplement: 27.Google Scholar
  58. 58.
    Petersen, E. A., Friedman, B. A., Crowder, E. D., Rifkind, D. Coccidioidouria: clinical significance. Annals of Internal Medicine 1976, 85: 34–38.PubMedGoogle Scholar
  59. 59.
    DeFelice, R., Wieden, M. A., Galgiani, J. N. The incidence and implications of coccidioidouria. American Review of Respiratory Disease 1982, 125: 49–52.PubMedGoogle Scholar
  60. 60.
    Conner, W. T., Drach, G. W., Bucher, Jr., W. C. Genitourinary aspects of disseminated coccidioidomycosis. Journal of Urology 1975, 113: 82–88.PubMedGoogle Scholar
  61. 61.
    Stadalnik, R. C., Goldstein, E., Hoeprich, P. D., dos Santos, P. A. L., Lee, K. K. Diagnostic value of gallium and bone scans in evaluation of extrapulmonary coccidioidal lesions. American Review of Respiratory Disease 1980, 121: 673–676.PubMedGoogle Scholar
  62. 62.
    Howard, P. F., Smith, J. W. Diagnosis of disseminated coccidioidomycosis by liver biopsy. Archives of Internal Medicine 1983, 143: 1335–1338.PubMedGoogle Scholar
  63. 63.
    Ampel, N. M., Ryan, K. J., Carry, P. J., Wieden, M. A., Schifman, R. B. Fungemia due toCoccidioides immitis. Medicine 1986, 65: 312–321.PubMedGoogle Scholar
  64. 64.
    American Thoracic Society Board of Directors Chemotherapy of the pulmonary mycoses. American Review of Respiratory Disease 1988, 138: 1078–1081.Google Scholar
  65. 65.
    Galgiani, J. N. Ketoconazole in the treatment of coccidioidomycosis. Drugs 1983, 26: 355–363.PubMedGoogle Scholar
  66. 66.
    Galgiani, J. N., Stevens, D. A., Graybill, J. R., Dismukes, W. E., Cloud, G. A. Ketoconazole therapy of progressive coccidioidomycosis: comparison of 400- and 800-mg doses and observations at higher doses. American Journal of Medicine 1988, 84: 603–610.PubMedGoogle Scholar
  67. 67.
    Dismukes, W. E. Azole antifungal drugs: old and new. Annals of Internal Medicine 1988, 109: 177–179.PubMedGoogle Scholar
  68. 68.
    DeFelice, R., Galgiani, J. N., Campbell, S. C., Palpant, S. D., Friedman, B. A., Dodge, R. R., Weinberg, M. G., Lincoln, L. J., Tennican, P. O., Barbee, R. A. Ketoconazole treatment of non-primary coccidioidomycosis: evaluation of 60 patients during three years of study. American Journal of Medicine 1982, 72: 681–687.PubMedGoogle Scholar
  69. 69.
    Stevens, D. A., Stiller, R. L., Williams, P. L., Sugar, A. M. Experience with ketoconazole in three major manifestations of progressive coccidioidomycosis. American Journal of Medicine 1983, 74: 58–63.PubMedGoogle Scholar
  70. 70.
    Catanzaro, A., Friedman, P. J., Schillaci, R., Einstein, H., Kirkland, T. N., Levine, H. B., Ross, J. B. Treatment of coccidioidomycosis with ketoconazole: an evaluation utilizing a new scoring system. American Journal of Medicine 1983, 74: 64–69.Google Scholar
  71. 71.
    Grant, A. R., Melick, D. W. The surgical treatment of cavitary pulmonary coccidioidomycosis. Archives of Surgery 1967, 94: 559–566.PubMedGoogle Scholar
  72. 72.
    Bayer, A. S. Fungal pneumonias: pulmonary coccidioidal syndromes (Part 2). Miliary, nodular, and cavitary pulmonary coccidioidomycosis chemotherapy and surgical considerations. Chest 1981, 79 686–691.PubMedGoogle Scholar
  73. 73.
    Bindschadler, D. D., Bennett, J. E. A pharmacologic guide to the clinical use of amphotericin B. Journal of Infectious Diseases 1969, 120: 427–436.PubMedGoogle Scholar
  74. 74.
    Labadie, E. L., Hamilton, R. H. Survival improvement in coccidioidal meningitis by high-dose intrathecal amphotericin B. Archives of Internal Medicine 1986, 146: 2013–2018.PubMedGoogle Scholar
  75. 75.
    Craven, P. C., Graybill, J. R., Jorgensen, J. H., Dismukes, W. E., Levine, B. E. High-dose ketoconazole for treatment of fungal infections of the central nervous system. Annals of Internal Medicine 1983, 98: 160–167.PubMedGoogle Scholar
  76. 76.
    Goodpasture, H. C., Hershberger, R. E., Barnett, A. M., Peterie, J. D. Treatment of central nervous system fungal infection with ketoconazole. Archives of Internal Medicine 1985, 145: 879–880.PubMedGoogle Scholar
  77. 77.
    Shehab, Z. M., Britton, H., Dunn, J. H. Imidazole therapy of coccidioidal meningitis in children. Pediatric Infectious Disease Journal 1988, 7: 40–44.PubMedGoogle Scholar
  78. 78.
    Tucker, R. L., Williams, P. L., Arathoon, E. G., Levine, B. E., Hartstein, A. I., Hanson, L. H., Stevens, D. A. Pharmacokinetics of fluconazole in cerebrospinal fluid and serum in human coccidioidal meningitis. Antimicrobial Agents and Chemotherapy 1988, 32: 369–373.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1989

Authors and Affiliations

  • D. A. Bronnimann
    • 1
  • J. N. Galgiani
    • 1
    • 2
  1. 1.Department of Internal Medicine and Division of Respiratory SciencesUniversity of Arizona College of MedicineTucsonUSA
  2. 2.Medical ServiceVeterans Administration Medical CenterTucsonUSA

Personalised recommendations