Coccidioidomycosis: Difference between revisions

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==Overview==
'''Coccidioidomycosis''' (also known as '''Valley fever''', '''San Joaquin Valley Fever''', '''California valley fever''', '''desert fever,''' and (incorrectly) '''coccidiomycosis''') is a [[fungus|fungal]] disease caused by ''[[Coccidioides immitis]]'' or ''[[Coccidioides posadasii|C. posadasii]]''.<ref name=Baron>{{cite book | author = Walsh TJ, Dixon DM | title =  Spectrum of Mycoses. ''In:'' Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref>  It is [[endemic (epidemiology)|endemic]] in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah and northwestern Mexico.<ref name=Hector_2005>{{cite journal | author = Hector R, Laniado-Laborin R | title = Coccidioidomycosis--a fungal disease of the Americas. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e2 | year = 2005 | url = http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020002| id=PMID 15696207}}</ref>
''C. immitis'' resides in the soil in certain parts of the southwestern [[United States]], northern Mexico, and parts of Central and South America [http://www.mayoclinic.com/print/valley-fever/DS00695/DSECTION=all&METHOD=print].  It is dormant during long dry spells, then develops as a mold with long filaments that break off into airborne spores when the rains come.  The spores, known as [[arthroconidia]], are swept into the air by disruption of the soil, such as during construction or farming.  Infection is caused by inhalation of the particles. 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. 


The disease is usually mild, with flu-like symptoms and rashes, and the Mayo Clinic estimates that half the population in some affected areas have suffered from the disease.  On occasion, those particularly susceptible, including pregnant women, people with weakened immune systems, and those of Asian, Hispanic and African descent, may develop a serious or even fatal illness from valley fever.  Serious complications include severe [[pneumonia]], [[lung nodule]]s, and disseminated disease, where the fungus spreads throughout the body.  The disseminated form of valley fever can devastate the body, causing skin ulcers and [[abscess]]es to bone lesions, severe joint pain, heart inflammation, [[urinary tract]] problems, [[meningitis]], and death.
==[[Coccidioidomycosis overview|Overview]]==


It has been known to infect humans, dogs, cattle, livestock, llamas, apes, monkeys, kangaroos, wallabies, tigers, bears, badgers, otters and marine mammals. <ref>Valley Fever Center for Excellence url = http://www.vfce.arizona.edu/VFID-other.htm</ref>
==[[Coccidioidomycosis historical perspective|Historical Perspective]]==
 
==[[Coccidioidomycosis pathophysiology|Pathophysiology]]==
 
==[[Coccidioidomycosis epidemiology and demographics|Epidemiology & Demographics]]==
 
==[[Coccidioidomycosis risk factors|Risk Factors]]==
 
==[[Coccidioidomycosis screening|Screening]]==
 
==[[Coccidioidomycosis causes|Causes]]==
 
==[[Coccidioidomycosis differential diagnosis|Differentiating Coccidioidomycosis]]==
 
==[[Coccidioidomycosis natural history|Complications & Prognosis]]==
 
==Diagnosis==
[[Coccidioidomycosis history and symptoms|History and Symptoms]] | [[Coccidioidomycosis physical examination|Physical Examination]] | [[Coccidioidomycosis staging|Staging]] | [[Coccidioidomycosis laboratory tests|Laboratory tests]] | [[Coccidioidomycosis electrocardiogram|Electrocardiogram]] | [[Coccidioidomycosis x ray|X Rays]] | [[Coccidioidomycosis CT|CT]] | [[Coccidioidomycosis MRI|MRI]] [[Coccidioidomycosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Coccidioidomycosis other imaging findings|Other images]] | [[Coccidioidomycosis other diagnostic studies|Alternative diagnostics]]
 
==Treatment==
[[Coccidioidomycosis medical therapy|Medical therapy]] | [[Coccidioidomycosis surgery|Surgical options]] | [[Coccidioidomycosis primary prevention|Primary prevention]]  | [[Coccidioidomycosis secondary prevention|Secondary prevention]] | [[Coccidioidomycosis cost-effectiveness of therapy|Financial costs]] | [[Coccidioidomycosis future or investigational therapies|Future therapies]]


Symptomatic infection (40% of cases) usually presents as an [[influenza]]-like illness with fever, cough, headaches, [[rash]], and [[myalgia]] (muscle pain).<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = pp. 680-83 | publisher = McGraw Hill | year = 2004 | id = ISBN 0838585299 }}</ref> 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.<ref name=Ampel_2005>{{cite journal | author = Ampel N | title = Coccidioidomycosis in persons infected with HIV type 1. | journal = Clin Infect Dis | volume = 41 | issue = 8 | pages = 1174-8 | year = 2005 | id = PMID 16163637}}</ref>  The disease can be fatal.


[[Image:Geographic_Distribution_of_Coccidioidomycosis_02.png|left|thumb|300px|Geographic distribution of coccidioidomycosis.]]
[[Image:Geographic_Distribution_of_Coccidioidomycosis_02.png|left|thumb|300px|Geographic distribution of coccidioidomycosis.]]
==Occurrence==
==Occurrence==
California state prisons have been particularly affected by Coccidioidomycosis, as far back as 1919. In 2005 and 2006, the Pleasant Valley State Prison near Coalinga and Avenal State Prison near Avenal on the western side of the San Joaquin Valley had the highest incidence rate in 2005, of at least 3,000 per 100,000 [http://www.blackwell-synergy.com/doi/abs/10.1196/annals.1406.011].
California state prisons have been particularly affected by Coccidioidomycosis, as far back as 1919. In 2005 and 2006, the Pleasant Valley State Prison near Coalinga and Avenal State Prison near Avenal on the western side of the San Joaquin Valley had the highest incidence rate in 2005, of at least 3,000 per 100,000 [http://www.blackwell-synergy.com/doi/abs/10.1196/annals.1406.011].

Revision as of 14:34, 1 February 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

Historical Perspective

Pathophysiology

Epidemiology & Demographics

Risk Factors

Screening

Causes

Differentiating Coccidioidomycosis

Complications & Prognosis

Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies


Geographic distribution of coccidioidomycosis.

Occurrence

California state prisons have been particularly affected by Coccidioidomycosis, as far back as 1919. In 2005 and 2006, the Pleasant Valley State Prison near Coalinga and Avenal State Prison near Avenal on the western side of the San Joaquin Valley had the highest incidence rate in 2005, of at least 3,000 per 100,000 [2].

Biological Warfare

C. immitis was investigated by the United States during the 1950s and 1960s as a potential biological weapon. 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.

Pathology

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Popular culture

The illness is mentioned in episode Lines in the Sand 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 the TV series Bones, 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

External links

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