Coccidioidomycosis - disseminated

Definition

Disseminated coccidioidomycosis is a fungal infection that spreads through the bloodstream and involves many organs.

Alternative Names

Coccidioidomycosis - systemic

Causes, incidence, and risk factors

Coccidioidomycosis is caused by breathing in spores from the fungi Coccidioides immitis or Coccidioides posadasii. These fungi are found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

The following increase your risk of disseminated coccidioidomycosis:

• Diabetes
• A suppressed immune system (immunosuppression), such as that caused by HIV infection or AIDS
• Pregnancy
• Medicines that weaken your immune system, including steroids, TNF-inhibitors, and chemotherapy drugs
• Lymphoma

Symptoms

Most acute infections cause no symptoms. Other times, the symptoms range from mild to severe.

Symptoms include:

• Cough
• Fever
• Chills
• Headache
• Muscle stiffness
• Muscle aches
• Neck or shoulder stiffness
• Change in mental status
• Sensitivity to light

Other symptoms that may occur with this disease:

• Joint swelling
• Joint pain
• Skin reaction (erythema nodosum)
• Arthritis
• Ankle, feet, and leg swelling

Signs and tests

Tests that may be done include:

• CBC with differential
• Chest x-ray
• Coccidioidin skin test
• Sputum KOH test
• Coccidioides complement fixation titer to measure antibodies to the Coccidioides fungus in the blood
• Sputum culture

A biopsy of tissue may be done to determine the area of disseminated disease:

• Bone marrow biopsy
• Liver biopsy
• Open lung biopsy
• Skin lesion biopsy

A brain and nervous system (neurological) examination may show abnormalities.

Treatment

Bed rest and improved nutrition are recommended. Antifungal drugs are prescribed to treat the infection.

Expectations (prognosis)

People with disseminated disease have a high death rate. Death may be rapid for patients with a suppressed immune system.

Complications

In the disseminated form of the disease, the infection may spread to the bones, lungs, liver, brain, skin, heart, and sac around the heart (pericardium). Meningitis is the most serious type of disseminated disease.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of disseminated coccidioidomycosis.

Prevention

Maintaining good health will limit the disease to a harmless lung illness. Preventing AIDS or other causes of an impaired immune system will generally prevent the more severe forms of the disease.

References

Galgiani J. Coccidioides species. In: Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005:chap 264.

Galgiani JN. Coccidioidomycosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 354.