Coccidioidomycosis - acute pulmona... Health Article

Definition

Acute pulmonary coccidioidomycosis is a lung infection caused by breathing in spores of Coccidioides immitis, a fungus found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

Causes, incidence, and risk factors

Coccidioides infection begins in the lungs, following inhalation of the spores. About 60% of infections resolve without ever causing symptoms and are only recognized by a positive coccidioidin skin test.

In the remaining 40% of infections, symptoms range from mild (cold-like or flu-like) to severe (pneumonia). (See coccidioidomycosis.) In less than 1% of infections, widespread disease occurs when the fungus spreads from the lungs through the blood stream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.

Individuals of African or Philippine descent, and people with weakened immune systems due to AIDS, diabetes, or immunosuppressive medications, may develop more serious infections. Occasionally the acute infection may develop into a chronic pulmonary (lung) disease or can reactivate after a long latent period.

A history of travel to an endemic region is the key to suspecting coccidioidal infection. Arizona, California (especially San Joaquin Valley), and -- to a lesser extent -- western Texas, are endemic regions in the USA.

Symptoms

• Cough
• Sputum or phlegm
• Chest pain, varies from mild sense of constriction to severe
• Fever
• Chills
• Night sweats
• Headache
• Muscle stiffness
• Muscle aches
• Joint stiffness
• Rash, may be painful, red, on lower legs (erythema nodosum)
• Weight loss
• Lymph node swelling

See also Skin lesion of coccidioidomycosis.

Signs and tests

• Sputum smear (KOH test or Papanicolaou stain)
• Bronchoscopy with lavage
• Biopsy of lymph node or lung (often done with bronchoscopy)

Treatment

The acute disease usually goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.

In severe forms of the disease (for example,disseminated coccidioidomycosis), antifungal treatment with amphotericin B, fluconazole, or itraconazole may be needed. The best length of treatment with these medications has not been determined for this disease.