Coccidioidomycosis

• Wernicke 1892
• Posadas 1892

Coccidioid granuloma, desert rheumatism, valley fever, California disease, coccidioidomycosis, San Joaquin valley fever, desert fever.

Systemic fungal infection, mainly occurring in America.

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

• Pathogen: Coccidioides immitis, a dimorphic fungus 
• Incubation period: 10-18 days
• The transmission takes place via dust. Primary infection can lead to the occurrence of erythema nodosum or erythema exsudativum multiforme
• In < 1% of cases haematogenic scattering leads to further organ infestation (skin, bone and CNS)
• Association with immunosuppression

• The pathogens are inhaled via lungs, where inoculation occurs. The infection rarely occurs via skin. 
• Flu-like symptoms (febrile temperatures, thoracic pain, cough, dyspnea, haemoptoe). 
• Cutaneously, one can see verruciform, scar-healing granulomas, especially in the area of the nasolabial folds and on the capillitium. Abscess and fistula formation may occur

• Pathogen detection (pus, sputum, bronchoalveolar lavage, blood, urine or cerebrospinal fluid) 
• Biopsy 
• Serologically specific antibody detection 
• Intradermal skin test

Meningitis.

• The disseminated form can lead to a lethal course, if untreated.  
• Frequent relapses. 

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