Fungus

Coccidioidomycosis

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Coccidioidomycosis, Coccidiomycosis, Coccidioides immitis

  • Epidemiology
  1. Important opportunistic infection in southwestern US
  • Pathophysiology
  1. Infection with fungus Coccidioides immitis
  • Symptoms
  1. Chills, weight loss
  2. Productive cough
  3. Chest Pain
  4. Arthralgias
  • Signs
  1. Fever
  2. Cervical adenopathy
  3. Skin lesions
    1. Resemble Erythema Nodosum
  4. Lung
    1. Pleural Effusion
    2. Friction rub
    3. Pulmonary rales
  • Lab
  1. Sputum KOH
    1. Positive for fungal elements
  2. Blood complement-fixing antibodies
    1. Positive
  • Diagnosis
  1. Coccidioidomycosis serology: IgM
    1. IgM positive by third week in 90% of patients
    2. Becomes negative 3 months after infection
  2. Complement fixation of IgG
    1. Low sensitivity, but high Specificity
  3. Skin Testing (for epidemiologic studies)
    1. Coccidioidin skin test
    2. Spherulin skin test
  • Differential Diagnosis in HIV patients
  • Affected Organs
  1. Lung most commonly affected (similar to Pneumocystis)
  • Management
  1. Disseminated disease
    1. Amphotericin B
  2. Palliative Therapy
    1. Fluconazole 600-800 mg/day
    2. Itraconazole 400 mg/day