Coccidioidomycosis

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Definition

Coccidioidomycosis is an infection caused by inhaling the microscopic spores of the fungus Coccidioides immitis. Spores are the tiny, thick-walled structures that fungi use to reproduce. Coccidioidomycosis exists in three forms. The acute form produces flu-like symptoms. The chronic form can develop as many as 20 years after initial infection and, in the lungs, can produce inflamed, injured areas that can fill with pus (abscesses). Disseminated coccidioidomycosis describes the type of coccidioidomycosis that spreads throughout the body affecting many organ systems and is often fatal.

Description

Coccidioidomycosis is an airborne infection. The fungus that causes the disease is found in the dry desert soil of the southwestern United States, Mexico, and Central and South America. Coccidioidomycosis is sometimes called San Joaquin fever, valley fever, or desert fever because of its prevalence in the farming valleys of California. Although commonly acquired, overt coccidioidomycosis is a rare disease. Chronic infections occur in only one out of every 100,000 people.

Although anyone can get coccidioidomycosis, farm laborers, construction workers, and archaeologists who work where it is dusty are at greater risk to become infected. People of any age can get coccidioidomycosis, but the disease most commonly occurs in the 25–55 age group. In its acute form, coccidioidomycosis infects men and women equally.

Chronic and disseminated forms of coccidioidomycosis occur more frequently in men and pregnant women. Although it is not clear why, people of color are 10-20 times more likely to develop the disseminated form of the disease than caucasians. People who have a weakened immune system (immunocompromised), either from diseases such as AIDS or leukemia, or as the result of medications that suppressed the immune system (corticosteroids, chemotherapy), are more likely to develop disseminated coccidioidomycosis.

— Tish Davidson

Dictionary: coc·cid·i·oi·do·my·co·sis  (kŏk-sĭd'ē-oi'dō-mī-kō'sĭs)

An infectious respiratory disease of humans and other animals caused by inhaling the fungus Coccidioides immitis. It is characterized by fever and various respiratory symptoms. Also called valley fever.

[New Latin Coccidioīdēs, genus name (from Coccidium, former genus name; see coccidium + -oīdēs, from Greek -oeidēs, -oid) + MYCOSIS.]

An infectious fungal disease caused by the inhalation of spores of the bacterium Coc-cidioides immitis, which is carried on windborne dust particles. Although endemic in the southeastern United States, coccidioidomycosis is considered among the opportunistic infections that are indicators of AIDS.

A fungal disease of humans and animals caused by infection with Coccidioides immitis. This fungus grows in hot, dry areas, especially in the southwestern USA, Mexico, and parts of Central and South America. It is characterized by granulomatous lesions, especially in the respiratory system and bones, which resemble tuberculosis in cattle and caseous lymphadenitis in sheep. In dogs, the predominant lesions are in bone, lungs and skin. In endemic areas, many people and animals experience asymptomatic or mild, undiagnosed respiratory infection. Dissemination is more common in some races of humans and in dogs, Boxers and Doberman pinschers. Called also San Joaquin Valley fever, valley fever, desert fever.

Disseminated coccidioidomycosis in the radius and ulna of a dog. By permission from Ettinger SJ, Feldman E, Textbook of Veterinary Internal Medicine, Saunders, 2004

Coccidioidomycosis
Classification & external resources

Histopathological changes in a case of coccidioidomycosis of the lung showing a large fibrocaseous nodule.
ICD-10	B38.
ICD-9	114
MedlinePlus	001322
eMedicine	med/103  ped/423
MeSH	D003047

Coccidioidomycosis (also known as Valley fever, California valley fever, and (incorrectly) coccidiomycosis) is a fungal disease caused by Coccidioides immitis or C. posadasii.^[1] It is endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah and northwestern Mexico.^[2]

C. immitis resides in the soil in certain parts of the southwestern United States, northern Mexico, and a few other areas in the Western Hemisphere. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, which are a form of spore. The disease is not transmitted from person to person. C. immitis is a dimorphic saprophytic organism that grows as a mycelium in the soil and produces a spherule form in the host organism.

It has been known to infect humans, dogs, cattle, livestock, llamas, apes, monkeys, kangaroos, wallabies, tigers, bears, badgers, otters and marine mammals. ^[3]

Symptomatic infection (40% of cases) usually presents as an influenza-like illness with fever, cough, headaches, rash, and myalgia (muscle pain).^[4] Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting meninges, soft tissues, joints, and bone). Severe pulmonary disease may develop in HIV-infected persons.^[5]

Geographic distribution of coccidioidomycosis.

Biological Warfare

C. immitis was investigated by the United States during the 1950s and 1960s as a potential biological weapon.^{[citation needed]} The Cash strain received the military symbol OC, and original hopes were for its use as an incapacitant. As medical epidemiology later made clear, OC would have lethal effects on several segments of the population, so it was later considered a lethal agent. It was never standardized, and beyond a few field trials, it was never weaponized. Most military work on OC was on vaccines by the mid-1960s.

Diagnostic test

The fungal infection can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and biopsy-tissue. With specific nucleotide primers C.immitis DNA can be amplified by PCR. It can also be detected in culture by morphological identification or by using molecular probes that hybridize with C.immitis RNA. An indirect demonstration of fungal infection can be achieved also by serologic analysis detecting fungal antigen or host antibody produced against the fungus.

Popular culture

The illness is mentioned in episode 3x04 of the TV Show House, as the cause of a young girl's loss of inhibition. The illness does not actually cause loss of inhibition, nor does it cause milky tears. This was not a factual error in the episode: House was tricking the girl, however this was not obvious to many viewers.

It is also the center of an episode of Bones (1x09), The Man In the Fallout Shelter. After being exposed to the fungus, the team was quarantined over Christmas to determine whether or not they had become infected. It was erroneously claimed to be contagious from person to person.

References

1. ^ Walsh TJ, Dixon DM (1996). Spectrum of Mycoses. In: Baron's Medical Microbiology (Baron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1. 
2. ^ Hector R, Laniado-Laborin R (2005). "Coccidioidomycosis--a fungal disease of the Americas.". PLoS Med 2 (1): e2. PMID 15696207. 
3. ^ Valley Fever Center for Excellence | url = http://www.vfce.arizona.edu/VFID-other.htm
4. ^ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, pp. 680-83. ISBN 0838585299. 
5. ^ Ampel N (2005). "Coccidioidomycosis in persons infected with HIV type 1.". Clin Infect Dis 41 (8): 1174-8. PMID 16163637. 

External links

Wikimedia Commons has media related to:

Coccidioidomycosis

• U.S. Centers for Disease Control and Prevention page on Coccidioidomycosis
• Medline Plus Entry for Coccidioidomycosis
• Valley Fever Vaccine Project of the Americas
• Valley Fever Connections
• Valley Fever Center for Excellence

Mycoses (B35-B49, 110-118)
Tinea: Dermatophytosis	Tinea barbae/Tinea capitis - Tinea unguium/Onychomycosis - Tinea manuum - Athlete's foot - Tinea corporis - Tinea cruris
Tinea: Other superficial mycoses	Tinea versicolor - Tinea nigra - White piedra
Dimorphic fungi	Coccidioidomycosis - Histoplasmosis - Blastomycosis - Paracoccidioidomycosis - Sporotrichosis
Other	Candidiasis (Oral candidiasis) - Chromoblastomycosis - Aspergillosis - Cryptococcosis - Phycomycosis/Mucormycosis - Mycetoma (Eumycetoma, Maduromycosis, Actinomycetoma) - Lobo's disease - Pneumocystis pneumonia

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