Coccidioidomycosis
Coccidioidomycosis | |
---|---|
Antifungal medication[1] | |
Medication | Amphotericin B, itraconazole, fluconazole[1] |
Coccidioidomycosis (
C. immitis is a
Coccidioidomycosis is a common cause of
Description
Coccidioidomycosis is a mammalian
C. immitis is a
Coccidioidomycosis is a common cause of
It was reported in 2022 that valley fever had been increasing in California's Central Valley for years (1,000 cases in
Classification
After Coccidioides infection, coccidioidomycosis begins with Valley fever, which is its initial acute form. Valley fever may progress to the chronic form and then to disseminated coccidioidomycosis.[11] Therefore, coccidioidomycosis may be divided into the following types:[12]
- Acute coccidioidomycosis, sometimes described in literature as primary pulmonary coccidioidomycosis
- Chronic coccidioidomycosis
- Disseminated coccidioidomycosis, which includes primary cutaneous coccidioidomycosis
Valley fever is not a contagious disease.[4] In some cases the infection may recur or become chronic.
Signs and symptoms
An estimated 60% of people infected with the fungi responsible for coccidioidomycosis have minimal to no symptoms, while 40% will have a range of possible clinical symptoms.
A minority (3–5%) of infected individuals do not recover from the initial acute infection and develop a chronic infection. This can take the form of chronic lung infection or widespread disseminated infection (affecting the tissues lining the brain, soft tissues, joints, and bone). Chronic infection is responsible for most of the morbidity and mortality. Chronic fibrocavitary disease is manifested by cough (sometimes productive of mucus), fevers, night sweats and weight loss.[13] Osteomyelitis, including involvement of the spine, and meningitis may occur months to years after initial infection. Severe lung disease may develop in HIV-infected persons.[15]
Complications
Serious complications may occur in patients who have weakened immune systems, including severe
A particularly severe case of meningitis caused by valley fever in 2012 initially received several incorrect diagnoses such as sinus infections and cluster headaches. The patient became unable to work during diagnosis and original search for treatments. Eventually the right treatment was found—albeit with severe side effects—requiring four pills a day and medication administered directly into the brain every 16 weeks.[10]
Cause
C. immitis is a
Rain starts the cycle of initial growth of the fungus in the soil.
Diagnosis
Coccidioidomycosis diagnosis relies on a combination of an infected person's signs and symptoms, findings on radiographic imaging, and laboratory results.[4] The disease is commonly misdiagnosed as bacterial community-acquired pneumonia.[4] The fungal infection can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and biopsy tissue by methods of Papanicolaou or Grocott's methenamine silver staining. These stains can demonstrate spherules and surrounding inflammation.[citation needed]
With specific nucleotide primers, C. immitis DNA can be amplified by polymerase chain reaction (PCR). It can also be detected in culture by morphological identification or by using molecular probes that hybridize with C. immitis RNA. C. immitis and C. posadasii cannot be distinguished on cytology or by symptoms, but only by DNA PCR.[citation needed]
An indirect demonstration of fungal infection can be achieved also by serologic analysis detecting fungal
If the meninges are affected, CSF will show abnormally low glucose levels, an increased level of protein, and lymphocytic pleocytosis. Rarely, CSF eosinophilia is present.[citation needed]
Imaging
Prevention
Preventing coccidioidomycosis is challenging because it is difficult to avoid breathing in the fungus should it be present; however, the public health effect of the disease is essential to understand in areas where the fungus is endemic. Enhancing surveillance of coccidioidomycosis is key to preparedness in the medical field in addition to improving diagnostics for early infections.[20] There are no completely effective preventive measures available for people who live or travel through Valley fever-endemic areas. Recommended preventive measures include avoiding airborne dust or dirt, but this does not guarantee protection against infection. People in certain occupations may be advised to wear face masks.[21] The use of air filtration indoors is also helpful, in addition to keeping skin injuries clean and covered to avoid skin infection.[citation needed]
From 1998–2011, there were 111,117 U.S. cases of coccidioidomycosis logged in the National Notifiable Diseases Surveillance System (NNDSS).[22] Since many U.S. states do not require reporting of coccidioidomycosis, the actual numbers may be higher. The United States' Centers for Disease Control and Prevention (CDC) called the disease a "silent epidemic" and acknowledged that there is no proven anticoccidioidal vaccine available.[23] A 2001 cost-effectiveness analysis indicated that a potential vaccine could improve health as well as reducing total health care expenditures among infants, teens, and immigrant adults, and more modestly improve health but increase total health care expenditures in older age groups.[24]
Raising both surveillance and awareness of the disease while medical researchers are developing a human vaccine can positively contribute towards prevention efforts.[25][26] Research demonstrates that patients from endemic areas who are aware of the disease are most likely to request diagnostic testing for coccidioidomycosis.[27] Presently, Meridian Bioscience manufactures the so-called EIA test to diagnose the Valley fever, which however is known for producing a fair quantity of false positives. Recommended prevention measures can include type-of-exposure-based respirator protection for persons engaged in agriculture, construction and others working outdoors in endemic areas.[28][29] Dust control measures such as planting grass and wetting the soil, and also limiting exposure to dust storms are advisable for residential areas in endemic regions.[30]
Treatment
Significant disease develops in fewer than 5% of those infected and typically occurs in those with a weakened immune system.[31] Mild asymptomatic cases often do not require any treatment. Those with severe symptoms may benefit from antifungal therapy, which requires 3–6 months or more of treatment depending on the response to the treatment.[32] There is a lack of prospective studies that examine optimal antifungal therapy for coccidioidomycosis.[citation needed]
On the whole, oral
Toxicity
Conventional
The cost of the nephrotoxic AmB deoxycholate, in 2015, for a patient of 70 kilograms (150 lb) at 1 mg/kg/day dosage, was approximately
Epidemiology
Coccidioidomycosis is endemic to the western hemisphere between 40°N and 40°S, including certain parts of the United States in Arizona, California, Nevada, New Mexico, Texas, Utah, and northern Mexico.[6] The ecological niches are characterized by hot summers and mild winters with an annual rainfall of 10–50 ml.[41] The species are found in alkaline sandy soil, typically 10–30 cm below the surface. In harmony with the mycelium life cycle, incidence increases with periods of dryness after a rainy season; this phenomenon, termed "grow and blow", refers to growth of the fungus in wet weather, producing spores which are spread by the wind during succeeding dry weather. While the majority of cases are observed in the endemic region, cases reported outside the area are generally visitors, who contact the infection and return to their native areas before becoming symptomatic.[citation needed]
North America
In the United States, C. immitis is endemic to southern and central California with the highest presence in the San Joaquin Valley. C. posadassi is most prevalent in Arizona, although it can be found in a wider region spanning from Utah, New Mexico, Texas, and Nevada. An estimated 150,000 infections occur annually, with 25,000 new infections occurring every year.[contradictory] The incidence of coccidioidomycosis in the United States in 2011 (42.6 per 100,000) was almost ten times higher than the incidence reported in 1998 (5.3 per 100,000). In area where it is most prevalent, the infection rate is 2-4%.[42]
Incidence varies widely across the west and southwest. In Arizona, for instance, in 2007, there were 3,450 cases in Maricopa County, which in 2007 had an estimated population of 3,880,181[43] for an incidence of approximately 1 in 1,125.[44] In contrast, though southern New Mexico is considered an endemic region, there were 35 cases in the entire state in 2008 and 23 in 2007,[44] in a region that had an estimated 2008 population of 1,984,356,[45] for an incidence of approximately 1 in 56,695.
Infection rates vary greatly by county, and although population density is important, so are other factors that have not been proven yet. Greater construction activity may disturb spores in the soil. In addition, the effect of altitude on fungi growth and morphology has not been studied, and altitude can range from sea level to 10,000 feet or higher across California, Arizona, Utah and New Mexico.[citation needed]
In California from 2000 to 2007, there were 16,970 reported cases (5.9 per 100,000 people) and 752 deaths of the 8,657 people hospitalized. The highest incidence was in the San Joaquin Valley with 76% of the 16,970 cases (12,855) occurring in the area.[46] Following the 1994 Northridge earthquake, there was a sudden increase of cases in the areas affected by the quake, at a pace of over 10 times baseline.[47]
There was an outbreak in the summer of 2001 in Colorado, away from where the disease was considered endemic. A group of archeologists visited Dinosaur National Monument, and eight members of the crew, along with two National Park Service workers were diagnosed with Valley fever.[48]
California state prisons, beginning in 1919, have been particularly affected by coccidioidomycosis. In 2005 and 2006, the
Population risk factors
There are several populations that have a higher risk for contracting coccidioidomycosis and developing the advanced disseminated version of the disease. Populations with exposure to the airborne arthroconidia working in agriculture and construction have a higher risk. Outbreaks have also been linked to earthquakes, windstorms and military training exercises where the ground is disturbed.
History
The first case of what was later named coccidioidomycosis was described in 1892 in Buenos Aires by Alejandro Posadas, a medical intern at the Hospital de Clínicas "José de San Martín".[55] Posadas established an infectious character of the disease after being able to transfer it in laboratory conditions to lab animals.[56] In the U.S., Dr. E. Rixford, a physician from a San Francisco hospital, and T. C. Gilchrist, a pathologist at Johns Hopkins Medical School, became early pioneers of clinical studies of the infection.[57] They decided that the causative organism was a Coccidia-type protozoan and named it Coccidioides immitis (resembling Coccidia, not mild).[citation needed]
Dr. William Ophüls, a professor at Stanford University Hospital (San Francisco), discovered[58] that the causative agent of the disease that was at first called Coccidioides infection and later coccidioidomycosis[59] was a fungal pathogen, and coccidioidomycosis was also distinguished from Histoplasmosis and Blastomycosis. Further, Coccidioides immitis was identified as the culprit of respiratory disorders previously called San Joaquin Valley fever, desert fever, and Valley fever, and a serum precipitin test was developed by Charles E. Smith that was able to detect an acute form of the infection. In retrospect, Smith played a major role in both medical research and raising awareness about coccidioidomycosis,[60] especially when he became dean of the School of Public Health at the University of California at Berkeley in 1951.
Coccidioides immitis was considered by the United States during the 1950s and 1960s as a potential biological weapon.
In 2002, Coccidioides posadasii was identified as genetically distinct from Coccidioides immitis despite their morphologic similarities and can also cause coccidioidomycosis.[64]
It was reported in 2022 that valley fever had been increasing in
Research
As of 2023, there is no vaccine available to prevent infection with Coccidioides immitis or Coccidioides posadasii, but efforts to develop such a vaccine are underway.[66][67] As of 2021[update] Anivive Lifesciences and a team at the University of Arizona Medical School was developing a vaccine for use in dogs, which could eventually lead to a vaccine in humans.[68][69][70]
Other animals
Valley fever is not contagious.
In dogs, the most common symptom of coccidioidomycosis is a chronic cough, which can be dry or moist. Other symptoms include fever (in approximately 50% of cases), weight loss, anorexia, lethargy, and depression. The disease can disseminate throughout the dog's body, most commonly causing osteomyelitis (infection of the bone), which leads to lameness. Dissemination can cause other symptoms, depending on which organs are infected. If the fungus infects the heart or pericardium, it can cause heart failure and death.[71]
In cats, symptoms may include skin lesions, fever, and loss of appetite, with skin lesions being the most common.[72]
Other species in which Valley fever has been found include livestock such as cattle and horses; llamas; marine mammals, including sea otters; zoo animals such as monkeys and apes, kangaroos, tigers, etc.; and wildlife native to the geographic area where the fungus is found, such as cougars, skunks, and
Additional images
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Spherule and endospore forms of Coccidioides immitis
-
Mature spherule with endospores of Coccidioides immitis
In popular culture
- In the Season 1 episode of Bones called "The Man in the Fallout Shelter" the entire lab is exposed to coccidioidomycosis through inhalation of bone dust. Erroneously, the team is forced to quarantine in the lab on Christmas Eve to prevent the disease from spreading to the public (in real life, the disease is not contagious).[74]
- The lab is later exposed to it again in the Season 2 episode "The Priest in the Churchyard" from contaminated graveyard soil but only receives a series of injections rather than be forced to quarantine.[75]
- The lab is later exposed to it again in the Season 2 episode "
- Everything in Between, a 2022 Australian feature film, contains references to coccidioidomycosis.[76]
- In House Season 3 Episode 4, "Lines in the Sand", a 17-year-old patient who has been exposed to Coccidioides immitis exhibits symptoms of coccidioidomycosis.
- Thunderhead, a 1999 novel by Douglas Preston and Lincoln Child, uses the fungus and illness as a central plot point.
See also
- Coccidioides
- Coccidioides immitis
- Coccidioides posadasii
- Zygomycosis
- Medical geology
- List of cutaneous conditions
- Thunderhead, a 1999 novel by Douglas Preston and Lincoln Child which uses the fungus and illness as a central plot point.
References
- ^ ISBN 978-0-323-56866-1.
- ^ "ICD-11 - ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved June 26, 2021.
- ^ PMID 23824371.
- ^ PMID 24575994.
- ^ ISBN 978-1-4160-2999-1.
- ^ PMID 15696207.
- ^ PMID 34877441.
- ^ PMID 9062329.
- ^ PMID 735056.
- ^ a b c Anguiano, Dani (August 29, 2022). "'It took everything': the disease that can be contracted by breathing California's air". The Guardian. Article gives judgement of medical director and earth system scientist.
- ^ "Check for Complications | Valley Fever Center for Excellence". vfce.arizona.edu.
- ISBN 978-0-7216-2921-6.
- ^ S2CID 36888911.
- ISBN 978-0-7020-6830-0.
- PMID 16163637.
- ^ Galgiani J. N. Coccidioidomycosis. In: Cecil, Russell L., Lee Goldman, and D. A. Ausiello. Cecil Medicine. Philadelphia: Saunders Elsevier, 2007.
- S2CID 23498844.
- ^ "Mayo Clinic". Valley Fever. Mayo Clinic. May 27, 2015. Retrieved September 30, 2015.
- ^ a b "CDC". Fungal diseases: valley fever. CDC. July 20, 2015. Retrieved September 30, 2015.
- ^ PMID 21695034.
- ^ "Risk factors". Valley Fever Center for Excellence.
- ^ "Increase in Reported Coccidioidomycosis—United States, 1998–2011". Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. Retrieved July 6, 2013.
- ^ "Valley Fever: Awareness is Key". CDC Features. Centers for Disease Control and Prevention. Retrieved July 6, 2013.
- PMID 11747691.
- PMID 15283234.
- ^ "Valley Fever Vaccine Project" (PDF). Archived from the original (PDF) on February 1, 2014. Retrieved July 11, 2013.
- PMID 21029532.
- S2CID 21931825.
- ^ "Coccidioidomycosis (Valley Fever)". Health Information: Diseases & Conditions. California Department of Public Health. Archived from the original on July 8, 2013. Retrieved July 11, 2013.
- ^ "Coccidioidomycosis: Prevention" (PDF). Acute Communicable Disease Control Annual Morbidity Reports, Los Angeles County, 2002-2010. Retrieved July 12, 2013.
- ^ PMID 23068145.
- PMID 27470238.
- ^ Barron MA, Madinger NE (November 18, 2008). "Opportunistic Fungal Infections, Part 3: Cryptococcosis, Histoplasmosis, Coccidioidomycosis, and Emerging Mould Infections". Infections in Medicine. Archived from the original on March 14, 2010. Retrieved July 15, 2009.
- PMID 12650050.
- ^ Drug-Induced Nephrotoxicity: American Family Physician (2008 Sep 15;78(6):743-750)- Retrieved January 16, 2017
- ^ amphotericin B phospholipid complex: Medscape- Retrieved January 16, 2017
- ^ AmBisome Intravenous: WebMD - Retrieved January 16, 2017
- ^ Amphotec Intravenous: WebMD -Retrieved January 16, 2017
- ^ AmB colloidal versus AmB deoxycholate: ResearchGate; Antimicrobial Agents and Chemotherapy 35(9):1829-33 · October 1991 (printed from PubMed)- Retrieved January 17, 2017
- PMID 26595825.
- ^ PMID 23843703.
- ^ Hospenthal, Duane. "Coccidioidomycosis". Medscape. Retrieved October 18, 2015.
- ^ "U.S. Census Bureau, State & County QuickFacts". Archived from the original on February 26, 2016.
- ^ a b "Number of Reported Cases of Selected Notifiable Diseases by Category for each County, Arizona, 2007" (PDF). Arizona Department of Health Services. Retrieved July 10, 2013.
- ^ New Mexico Intercensal Population Estimates from the U.S. Census Bureau "New Mexico Intercensal Population Estimates". Archived from the original on February 22, 2012. Retrieved February 7, 2016.
- PMID 19214158.
- USGS Landslide Hazards Program. Archived from the originalon February 2, 2014.
- ^ "Coccidioidomycosis in Workers at an Archeologic Site ---Dinosaur National Monument, Utah, June--July 2001". Morbidity and Mortality Weekly Report (MMWR), 50(45), p. 1005-1008. Centers for Disease Control and Prevention (CDC). November 16, 2001. Retrieved July 10, 2013.
- S2CID 29147634.
- ^ Rachel Cook; Rebecca Plevin (May 7, 2013). "Some Prison Inmates to Be Moved Out of Valley Fever Hot Spots". Voice of OC. Retrieved May 9, 2013.
- ^ "CDC Says Calif. Inmates Should Be Tested for Valley Fever Immunity". California HealthLine. July 28, 2014.
- PMID 21056742.
- ^ Hospenthal, Duane (January 4, 2019). "Coccidioidomycosis". Medscape.
- ^ Cook, Rachel. "Just One Breath: More People Dying from Valley Fever – Especially Those With Chronic Disease, Study Shows". Reporting on Health. Archived from the original on July 12, 2015. Retrieved October 20, 2015.
- ^ Posadas A. Un nuevo caso de micosis fungoidea con posrospemias. Annales Cir. Med. Argent. (1892), Volume 15, p. 585-597.
- PMID 17407039.
- ^ Rixford E., Gilchrist T. C. Two cases of protozoan (coccidioidal) infection of the skin and other organs. Johns Hopkins Hosp Rep 1896; 10:209-268.
- PMID 17407039.
- .
- PMID 18015234.
- ^ Ciottone, Gregory R. Disaster Medicine. Philadelphia, PA: Mosby Elsevier, 2006, pp. 726-128.
- ^ "HHS select agents and toxins" (PDF). Code of Federal Regulations (CFR), Title 42 - Public Health. Office of the Federal Register. Archived from the original (PDF) on October 20, 2013. Retrieved July 11, 2013.
- ^ "Select Agents and Toxins List" (PDF). CDC. December 4, 2012. Archived from the original (PDF) on February 28, 2013. Retrieved July 11, 2013.
- PMID 21156479.
- ^ Teirstein, Zoya (February 12, 2024). "Intensifying atmospheric rivers are leading to a surge in Valley fever cases in California". Grist. Retrieved February 14, 2024.
- PMID 23864796.
- PMID 29376949.
- ^ "Valley Fever | Anivive Lifesciences". www.anivive.com. Retrieved February 1, 2023.
- ^ "Study Shows Vaccine Protects Dogs Against Valley Fever". UArizona Health Sciences. October 25, 2021. Retrieved February 1, 2023.
- ISSN 1059-1028. Retrieved February 1, 2023.
- PMID 18762558.
- PMID 7760314.
- ^ "Valley Fever Center for Excellence: Valley Fever in Other Animal Species". University of Arizona.
- ^ Yaitanes, Greg (December 13, 2005), The Man in the Fallout Shelter, Bones, retrieved December 16, 2022
- ^ Lautanen, Scott (March 28, 2007), The Priest in the Churchyard, Bones, retrieved December 16, 2022
- ^ "'Everything in Between' Storyline". IMDB. Retrieved September 1, 2022.
Further reading
- Twarog M, Thompson GR (2015). "Coccidioidomycosis: Recent Updates". Seminars in Respiratory and Critical Care Medicine. 36 (5): 746–755. S2CID 36888911. (Review).
- Stockamp NW, Thompson GR (2016). "Coccidioidomycosis". Infectious Disease Clinics of North America. 30 (1): 229–246. S2CID 265802757. (Review).