Coccidioidomycosis

Last Updated: 2020-08-11

Author(s): -

  • 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. 
  • Often asymptomatic course without indication for treatment.

 

Cutaneous form

  • Itraconazole p.o. 200 mg 1x daily for 6 months after absence of symptoms. 
  • Fluconazole p.o. 200 mg 1x daily for 3-6 months after absence of symptoms.  

 

Disseminated form

  • Amphotericin B i.v. initial 0.1 mg/kg bw/d, increasing to 1 mg/kg bw/d
  • Fluconazole p.o. 200 mg 1 x daily 
  • Posaconazole p.o. 400 mg 2x daily  
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