Coccidioidomycosis physical examination: Difference between revisions
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==Physical Findings== | ==Physical Findings== | ||
There are no pathognomic signs for Coccidioidomycosis, however numerous findings are observed depending on the organ system involved. Features suggestive of disseminated disease include : | 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. | ||
==Respiratory system== | ==Respiratory system== | ||
* Bronchial breathing. | * [[Bronchial breathing]]. | ||
* Rales & Ronchi | * [[Rales]] & [[Ronchi]] | ||
* Areas of consolidation with resultant dullness to percussion , and increased tactile and vocal fremitus. | * Areas of consolidation with resultant dullness to percussion , and increased tactile and vocal fremitus. | ||
* 5-10% cases may develop pulmonary nodules which may resolve spontaneously or may ulcerate and cause hemoptysis. | * 5-10% cases may develop pulmonary nodules which may resolve spontaneously or may ulcerate and cause [[hemoptysis]]. | ||
==Skin manifestations== | ==Skin manifestations== | ||
Revision as of 21:42, 19 November 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]
Physical Findings
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.
Respiratory system
- Bronchial breathing.
- Rales & Ronchi
- Areas of consolidation with resultant dullness to percussion , and increased tactile and vocal fremitus.
- 5-10% cases may develop pulmonary nodules which may resolve spontaneously or may ulcerate and cause hemoptysis.
Skin manifestations
Erythema nodosum presenting as tender, erythematous nodules, about 1-2 cm in size are classic in endemic areas.
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
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.
Musculoskeletal manifestations
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 contigous spread and may need surgical decompression to relieve cord compression.
Other organ systems
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.