Coccidioidomycosis physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(25 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Coccidioidomycosis}}
{{Coccidioidomycosis}}
{{CMG}}; {{AE}}; {{VB}}; {{ADG}}
==Overview==
The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are [[Lungs|lungs,]] [[skin]], [[bones]], [[genitourinary system]], [[central nervous system]] and other organs.<ref name="pmid26739609">{{cite journal |vauthors=Stockamp NW, Thompson GR |title=Coccidioidomycosis |journal=Infect. Dis. Clin. North Am. |volume=30 |issue=1 |pages=229–46 |year=2016 |pmid=26739609 |doi=10.1016/j.idc.2015.10.008 |url=}}</ref><ref name="pmid26398540">{{cite journal |vauthors=Twarog M, Thompson GR |title=Coccidioidomycosis: Recent Updates |journal=Semin Respir Crit Care Med |volume=36 |issue=5 |pages=746–55 |year=2015 |pmid=26398540 |doi=10.1055/s-0035-1562900 |url=}}</ref><ref name="pmid25577855">{{cite journal |vauthors=DiCaudo DJ |title=Coccidioidomycosis |journal=Semin Cutan Med Surg |volume=33 |issue=3 |pages=140–5 |year=2014 |pmid=25577855 |doi= |url=}}</ref><ref name="pmid24575994">{{cite journal |vauthors=Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS |title=Update on the diagnosis of pulmonary coccidioidomycosis |journal=Ann Am Thorac Soc |volume=11 |issue=2 |pages=243–53 |year=2014 |pmid=24575994 |doi=10.1513/AnnalsATS.201308-286FR |url=}}</ref>


{{CMG}}; {{AE}}; {{VB}}
==Physical Examination==
===Vital Signs===
*[[Fever]]
*[[Tachypnea]]


==Physical Findings==
===HEENT===
[[Photophobia]], [[episcleritis]], [[conjunctivitis]], [[scleritis]]


There are no pathognomic signs for Coccidioidomycosis, however numerous findings are observed depending on the organ system involved. Features suggestive of disseminated disease include: profuse sweating, dyspnea, high grade fever and weight loss. The various organ systems involved are.  
===Lymph nodes===
*In cases with [[skin]] involvement from direct [[inoculation]], regiona[[Lymphadenopathy|l lymph node enlargement]] may be seen.
===Neck===
*No masses
===Cardiovascular system===
*Regular rate and rhythm
*[[Heart sounds|Normal S1, S2]]
*No [[murmurs]], rubs, or [[Gallops and Extra Heart Sounds|gallops]]
===Lungs===
Findings consistent with [[Consolidation (medicine)|parenchymal consolidation]] such as<ref>{{cite book | last = Kauffman | first = Carol | title = Essentials of clinical mycology | publisher = Springer | location = New York | year = 2011 | isbn = 978-1-4419-6639-1 }}</ref>
*[[Percussion of the lungs|Dullness to percussion]]
*Increased [[fremitus]]
*[[Lung sounds|Bronchial breathing]].
*[[Rales]] & [[Ronchi]]


==Respiratory system==
===Abdominal===
*[[Abdomen]] soft and non-distended with no [[Scar|scars]] or striations
*No pulsatile [[Mass|masses]] or [[Abdominal bruit|abdominal bruits]] auscultated
*[[Spleen]] not palpable, [[liver]] not palpable


* [[Bronchial breathing]].
===Skin===
* [[Rales]] & [[Ronchi]]
*[[Erythema nodosum]] ( It presents as tender red [[nodules]] on the shins that are smooth and shiny)
* Areas of consolidation with resultant dullness to percussion , and increased tactile and vocal fremitus. 
*[[Erythema multiforme]]( classical "target lesion" appearance, with a pink-red ring around a pale center)
* 5-10% cases may develop pulmonary nodules which may resolve spontaneously or may ulcerate and cause [[hemoptysis]].
*Verrucous lesions with irregular border and variegated appearance
[[Image:Erythema-nodosum.jpg|500px|center|]]


==Skin manifestations==
===Bone and joints===
[[Image:Erythema-nodosum.jpg|200px]]


*Soft [[tissue]] [[swelling]] around the area of involvement and discharging [[sinuses]] might be consistent with [[osteomyelitis]].
*[[Arthritis]] can cause reproducible [[pain]] in [[joints]].


[[Erythema nodosum]] presenting as tender, erythematous nodules, about 1-2 cm in size are classic in endemic areas.
===Genitourinary system===
Ocular hypersensitivity is a frequent finding presenting as episcleritis,conjunctivitis, sclerities. Cutaneous hypersensitivity sometimes occur and needs to be differentiated from cutaneous involvement which is a bad prognostic sign.
classical skin manifestation of coccidioidomycosis is a verrucous granuloma at the nasolabial fold. 


==Meningitis==
*[[Pyuria]]
*[[Dysuria|Painful urination]]


Meningitis associated with coccidioidomycosis is usually more chronic in onset then acute and is a result of disseminated infection. It is a serious condition and may result in death. Symptoms of meningitis are more common and obvious, while other symptoms such as focal deficits and cranial nerve palsies are much less common. Increased intracranial pressure is a common finding and is often symptomatic.  
===Extremities===
*[[Ulcers]] that bleed on touch
===Neurological===
Normal examination findings are seen unless the [[infection]] is disseminated to the brain resulting in [[meningitis]], findings of [[neural]] involvement include:
*[[Consciousness|Altered level of consciousness]]
*[[Nuchal rigidity]]
*[[Increased intracranial pressure]] is a most common finding when [[meninges]] are involved.


==Musculoskeletal manifestations==
==Gallery==


It can present with a monoarticular arthritis which may sometimes be migratory, knees are the most commonly affected joint. scleroic or lytic bone lesions are also seen but are not as common as in blastomycosis. Joint involvement resulting in [[synovitis]] is observed but aspiration of synovial fluid does not give specific findings. Osteomyelitis from hematogenous spread and from direct inoculation can lead to chronic infections, which may ulcerate to surface to cause draining fistulas. Paraspinal abscesses can occur from contiguous spread and may need surgical decompression to relieve cord compression.
<gallery>


==Other organ systems==
Image: Coccidioidomycosis28.jpeg| Erythema nodosum lesions on skin of back due to hypersensitivity to antigens of Coccidioides immitis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coccidioidomycosis03.jpeg| Chronic lesion that had been determined to be due to a Coccidioides sp. fungal infection. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coccidioidomycosis01.jpeg|Large red spot formed at volar surface of patient's left arm, indicating a positive result to a skin test to determine whether patient was exposed to the Coccidioides spp. fungal organism. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Almost all other organs can be involved as well but the chances are minimal.




In people with HIV and other immuno-compromised diseases septic shock and fungemia may occur.
</gallery>
 
==References==
==References==


Line 42: Line 74:


{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Biological weapons]]
[[Category:Biological weapons]]
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Disease]]
{{WH}}
{{WS}}

Latest revision as of 21:00, 29 July 2020

Coccidioidomycosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Coccidioides immitis
Coccidioides posadasii

Differentiating Coccidioidomycosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Coccidioidomycosis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Coccidioidomycosis physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Coccidioidomycosis physical examination

CDC on Coccidioidomycosis physical examination

Coccidioidomycosis physical examination in the news

Blogs on Coccidioidomycosis physical examination

Directions to Hospitals Treating Coccidioidomycosis

Risk calculators and risk factors for Coccidioidomycosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]; Aditya Ganti M.B.B.S. [3]

Overview

The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are lungs, skin, bones, genitourinary system, central nervous system and other organs.[1][2][3][4]

Physical Examination

Vital Signs

HEENT

Photophobia, episcleritis, conjunctivitis, scleritis

Lymph nodes

Neck

  • No masses

Cardiovascular system

Lungs

Findings consistent with parenchymal consolidation such as[5]

Abdominal

Skin

  • Erythema nodosum ( It presents as tender red nodules on the shins that are smooth and shiny)
  • Erythema multiforme( classical "target lesion" appearance, with a pink-red ring around a pale center)
  • Verrucous lesions with irregular border and variegated appearance

Bone and joints

Genitourinary system

Extremities

Neurological

Normal examination findings are seen unless the infection is disseminated to the brain resulting in meningitis, findings of neural involvement include:

Gallery

References

  1. ↑ Stockamp NW, Thompson GR (2016). "Coccidioidomycosis". Infect. Dis. Clin. North Am. 30 (1): 229–46. doi:10.1016/j.idc.2015.10.008. PMID 26739609.
  2. ↑ Twarog M, Thompson GR (2015). "Coccidioidomycosis: Recent Updates". Semin Respir Crit Care Med. 36 (5): 746–55. doi:10.1055/s-0035-1562900. PMID 26398540.
  3. ↑ DiCaudo DJ (2014). "Coccidioidomycosis". Semin Cutan Med Surg. 33 (3): 140–5. PMID 25577855.
  4. ↑ Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS (2014). "Update on the diagnosis of pulmonary coccidioidomycosis". Ann Am Thorac Soc. 11 (2): 243–53. doi:10.1513/AnnalsATS.201308-286FR. PMID 24575994.
  5. ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
  6. ↑ 6.0 6.1 6.2 "Public Health Image Library (PHIL)".

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Coccidioidomycosis_physical_examination&oldid=1636219"