Coccidioidomycosis natural history
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]
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Natural History
- Coccidioidomycosis is usually a self-limited mild clinical illness.
- A large proportion of individuals are clinically infected without any manifestations and are thus completely asymptomatic.
- The remaining develop a mild pulmonary illness which in most cases is self limited requiring no treatment, and even those cases which do require treatment have an excellent prognosis.
- It is often misdiagnosed as community-acquired pneumonia. There are several cutaneous manifestations such as erythema multiforme and erythema nodosum, it may even cause arthritis and arthralgias.
- If left untreated in patients with weakened immune systems,the infection spreads throughout the body.
- The disseminated form of Coccidioidomycosis can devastate the body, causing skin ulcers, abscesses, bone lesions, swollen joints with severe pain, heart inflammation, urinary tract problems, and inflammation of the brain's lining, which can lead to death.[1]
Complications
Complications of coccidioidomycosis include:[2][3]
- Pleural effusion
- Return of the infection (relapse
- Meningitis
- Pulmonary cavities, that may rupture leading to pyopneumothroax, otherwise causing persistent cough, hemoptysis, and pleuritic chest pain.
- Synovitis and Osteomyelitis.
Prognosis
The prognosis of Coccidioidomycosis is excellent. Most infections are self-limited and resolve without treatment. The mortality rate is very low (<0.07%).
Factors associated with poor prognosis:
- HIV disease,with low CD4 count (<250)
- Late stage Pregnancy( third trimester)
- Organ transplantation
- Immunosuppresant therapy [4]
References
- ↑ Galgiani J. N. Coccidioidomycosis. In: Cecil, Russell L., Lee Goldman, and D. A. Ausiello. Cecil Medicine. Philadelphia: Saunders Elsevier, 2007.
- ↑ Angelo, KM.; Nnedu, ON. "Rare manifestations of coccidioidomycosis". J La State Med Soc. 165 (3): 137–9. PMID 24015425.
- ↑ Remesar, MC.; Blejer, JL.; Negroni, R.; Nejamkis, MR. "Experimental coccidioidomycosis in the immunosuppressed rat". Rev Inst Med Trop Sao Paulo. 34 (4): 303–7. PMID 1342086.
- ↑ Bergstrom L, Yocum DE, Ampel NM, Villanueva I, Lisse J, Gluck O, Tesser J, Posever J, Miller M, Araujo J, Kageyama DM, Berry M, Karl L, Yung CM (2004). "Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists". Arthritis Rheum. 50 (6): 1959–66. doi:10.1002/art.20454. PMID 15188373.