Coccidioidomycosis - chronic pulmo... Health Article

Definition

Chronic pulmonary coccidioidomycosis is a lung infection caused by breathing in the fungus Coccidioides.

Causes, incidence, and risk factors

The infection is caused by breathing in the spores of a fungus found in the soil in desert regions of the southwestern U.S., Mexico, and Central and South America. The disease can have an acute, chronic, or disseminated form.

People get the chronic form months or years after having a harmless infection that might have gone undiagnosed. Lung abscesses can form and may break open, causing pus in the lung cavity (empyema) or an abnormal connection between an air passage and the lung cavity (bronchopleural fistula). Scarring (fibrosis) and cavities can form in the upper lungs as chronic coccidioidomycosis slowly progresses over a period of months or years.

Most pulmonary coccidioidomycosis infections do not become chronic. They also usually don't cause symptoms and are only picked up by a positive coccidioidin skin test.

The following increase the risk for the chronic or disseminated forms of the disease:

• African or Phillippine descent
• Weak immune system
• Pregnancy
• Pre-existing heart or lung disease
• Diabetes

Symptoms

• Chronic cough
• Blood-tinged sputum
• Loss of appetite
• Weight loss
• Fever
• Shortness of breath

Other symptoms of this disease include:

• Wheezing
• Excess sweating
• Joint stiffness
• Chest pain
• Headache

Signs and tests

• Sputum smear (KOH test)
• Sputum fungal culture
• Blood coccidioides complement fixation titer (serology)
• CBC with differential
• Chest x-ray
• Chest CT scan
• Coccidioidin or spherulin skin test
• Bronchoscopy (possibly with transbronchial biopsy)
• Open lung biopsy
• Mediastinoscopy
• Spinal tap (lumbar puncture) to rule out meningitis

Treatment

Antifungal medications are used to treat the disease. Treating any immune system problem (such as AIDS) and limiting the use of medications that suppress the immune system (such as steroids or chemotherapy) can help the body fight the coccidioidomycosis infection.