Coccidioidomycosis

• Wernicke 1892
• Posadas 1892

Coccidioidal granuloma, desert rheumatism, valley fever, California disease, coccidioidomycosis, San Joaquin Valley Fever, valley fever, desert fever, desert rheumatism.

Systemic fungal infection occurring mainly in the Americas.

• Southern USA, Central and South America
• Up to 15 times more common in Asians and blacks

• Pathogen: Coccidioides immitis, a dimorphic fungus
• Incubation period: 10-18 days
• Transmission occurs via dust. In primary infection, erythema nodosum or erythema exsudativum multiforme may occur
• In 1% of cases, haematogenous spread leads to further organ involvement (skin, bone and CNS)
• Association with immunosuppression

• The pathogens are inhaled via the lungs, where inoculation occurs. Rarely, infection occurs through the skin
• Flu-like symptoms (febrile temperatures, thoracic pain, cough, dyspnoea, haemoptysis)
• Cutaneously, verrucous, scarring healing granulomas are seen, especially in the area of the nasolabial folds and on the capillitium. Abscess and fistula formation may occur

• Detection of pathogens (pus, sputum, bronchoalveolar lavage, blood, urine or cerebrospinal fluid)
• Biopsy
• Serological specific antibody detection
• Intracutaneous skin test

Meningitis

• The disseminated form can be lethal if left untreated
• Frequent relapses

• Often asymptomatic course without indication for treatment

Cutaneous form

• Itraconazole p.o. 200 mg 1x daily for 6 months after freedom from symptoms
• Fluconazole p.o. 200 mg 1x tgl. for 3-6 months after freedom from symptoms

Disseminated form

• Amphotericin B i.v. initially 0.1 mg/kg bw/d, increasing to 1 mg/kg bw/d in the course
• Fluconazole p.o. 200 mg 1x tgl.
• Posaconazole p.o. 400 mg 2x tgl.

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