Coccidioides immitis - Revision history

Aidan: /* Diagnosis */

2024-12-31T14:55:03Z

Diagnosis

← Older revision		Revision as of 14:55, 31 December 2024
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	*Culture: fluffy white colonies on routine bacterial or fungal cultures, often within a few days (grows quickly)		*Culture: fluffy white colonies on routine bacterial or fungal cultures, often within a few days (grows quickly)
	*Serology		*Serology
	**~~Immunodiffusion (ID)~~ for IgM and IgG		**EIA for IgM and IgG (used in Ontario)
			***Sensitivity and specificity of 11-57% and 70-100% for IgM, and 53-69% and 95-99% for IgG, varies by test and laboratory[[CiteRef::humphries2023re]]
⚫	***IgM on CSF for coccioidal meningitis
	**~~Complement~~ fixation for IgG		**Immunodiffusion (ID) for IgM and IgG, plus complement fixation (CF) for IgG
		⚫	***ID IgM on CSF for coccioidal meningitis
	**Beta glucan in blood or CSF, but isn't specific		**Beta glucan in blood or CSF, but isn't specific
	**Coccidioidal antigen (urine and serum), only useful in disseminated disease		**Coccidioidal antigen (urine and serum), only useful in disseminated disease

Aidan at 17:29, 19 September 2024

2024-09-19T17:29:35Z

← Older revision		Revision as of 17:29, 19 September 2024
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	== Investigations ==		== Investigations ==

			* CT chest[[CiteRef::jude2014pu]]
	* CT chest<ref>Jude CM, Nayak NB, Patel MK, Deshmukh M, Batra P. Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings. ''Radiographics''. 2014 Jul-Aug;34(4):912-25. doi: [https://doi.org/10.1148/rg.344130134 10.1148/rg.344130134]. PMID: [https://pubmed.ncbi.nlm.nih.gov/25019431/ 25019431].</ref>
	** Acute disease: lobar and segmental consolidations (75%); multifocal consolidation; nodules; rarely, miliary disease or confluent nodules with cavitation; may have adenopathy or pleural effusions; may have [[ARDS]]		** Acute disease: lobar and segmental consolidations (75%); multifocal consolidation; nodules; rarely, miliary disease or confluent nodules with cavitation; may have adenopathy or pleural effusions; may have [[ARDS]]
	** Chronic changes: residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes		** Chronic changes: residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes

Aidan at 17:13, 14 December 2023

2023-12-14T17:13:07Z

← Older revision		Revision as of 17:13, 14 December 2023
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	**Viral?		**Viral?
	*Non-infectious		*Non-infectious

			== Investigations ==

			* CT chest<ref>Jude CM, Nayak NB, Patel MK, Deshmukh M, Batra P. Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings. ''Radiographics''. 2014 Jul-Aug;34(4):912-25. doi: [https://doi.org/10.1148/rg.344130134 10.1148/rg.344130134]. PMID: [https://pubmed.ncbi.nlm.nih.gov/25019431/ 25019431].</ref>
			** Acute disease: lobar and segmental consolidations (75%); multifocal consolidation; nodules; rarely, miliary disease or confluent nodules with cavitation; may have adenopathy or pleural effusions; may have [[ARDS]]
			** Chronic changes: residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes

	==Diagnosis==		==Diagnosis==

Aidan: /* Management */

2020-09-13T01:57:59Z

Management

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 *Many do not need treatment, as infection is asymptomatic or self-limited
 *Indications
 *Treatment regimens
 **[[Is treated by::Fluconazole]] 400-800 mg/day

Aidan at 20:08, 12 September 2020

2020-09-12T20:08:02Z

Show changes

Aidan: /* Clinical Manifestations */

2020-08-05T14:05:34Z

Clinical Manifestations

← Older revision		Revision as of 14:05, 5 August 2020
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	== Clinical Manifestations ==		== Clinical Manifestations ==
	* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant		* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant
	* Incubation period 1-3 weeks		* Incubation period of [[Usual incubation period::1 to 3 weeks]]
	* Common symptoms:		* Common symptoms:
	** General: fever, arthralgia, myalgia, night sweats		** General: fever, arthralgia, myalgia, night sweats

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-22T13:37:32Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 13:37, 22 July 2020
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	* The spherules rupture, releasing the endospores and continuing the cycle		* The spherules rupture, releasing the endospores and continuing the cycle

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant		* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant
	* Incubation period 1-3 weeks		* Incubation period 1-3 weeks

Aidan: adjusted sections

2020-02-13T20:35:08Z

adjusted sections

← Older revision		Revision as of 20:35, 13 February 2020
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	* Dimorphic fungus in patients from arid areas in SW US and Mexico, which is mostly asymptomatic but can cause pulmonary disease, and rarely disseminated disease. Also called Joaquin Valley fever.		* Dimorphic fungus in patients from arid areas in SW US and Mexico, which is mostly asymptomatic but can cause pulmonary disease, and rarely disseminated disease. Also called Joaquin Valley fever.

	== ~~Microbiology~~ ==		== Background ==
			=== Microbiology ===

	* Dimorphic fungus with barrel-shaped arthroconidia in the septated hyphal filamentous form		* Dimorphic fungus with barrel-shaped arthroconidia in the septated hyphal filamentous form
	* Coccidiomycosis also caused by ''Coccidioides posadasii'' outside of California		* Coccidiomycosis also caused by ''Coccidioides posadasii'' outside of California

	== Epidemiology ==		=== Epidemiology ===
	[[File:Coccidiomycosis_map.png\|thumb\|Distribution of coccidiomycosis]]		[[File:Coccidiomycosis_map.png\|thumb\|Distribution of coccidiomycosis]]

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	* There is a strain with a mutation that can cause aggressive invasive disease in younger adults		* There is a strain with a mutation that can cause aggressive invasive disease in younger adults

	== Pathophysiology ==		=== Pathophysiology ===

	* Arthroconidia break off of the filamentous form and are inhaled (or inoculated)		* Arthroconidia break off of the filamentous form and are inhaled (or inoculated)
	* The then transform into invasive yeast form, characterized by spherules that contain hundreds of endospores		* The then transform into invasive yeast form, characterized by spherules that contain hundreds of endospores
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	== Clinical Presentation ==		== Clinical Presentation ==

	* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant		* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant
	* Incubation period 1-3 weeks		* Incubation period 1-3 weeks
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	=== Desert rheumatism ===		=== Desert rheumatism ===

	* Erythema nodosum		* Erythema nodosum
	* Fevers		* Fevers
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	=== Complications ===		=== Complications ===

	* Chronic pulmonary disease:		* Chronic pulmonary disease:
	** Residual lung nodules (~5%)		** Residual lung nodules (~5%)
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	=== Risk factors for disseminated disease ===		=== Risk factors for disseminated disease ===

	* Immunosuppression, including HIV/AIDS, pregnancy, TNF inhibitors, corticosteroids, and transplantation		* Immunosuppression, including HIV/AIDS, pregnancy, TNF inhibitors, corticosteroids, and transplantation
	* More common in non-Caucasian populations		* More common in non-Caucasian populations
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	== Differential Diagnosis ==		== Differential Diagnosis ==

	* Infectious		* Infectious
	** Bacterial: routine bacterial infections		** Bacterial: routine bacterial infections
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	== Diagnosis ==		== Diagnosis ==

	* Direct microscopy: typical spherules		* Direct microscopy: typical spherules
	* Culture: fluffy white colonies on routine bacterial or fungal cultures, often within a few days (grows quickly)		* Culture: fluffy white colonies on routine bacterial or fungal cultures, often within a few days (grows quickly)
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	== Management ==		== Management ==

	* Many do not need treatment, as infection is asymptomatic or self-limited		* Many do not need treatment, as infection is asymptomatic or self-limited
	* Indications		* Indications
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	=== Laboratory Exposure ===		=== Laboratory Exposure ===

	* Evacuate lab, seal lab, call Biosafety Officer on call		* Evacuate lab, seal lab, call Biosafety Officer on call
	* Assess risk to each individual exposed		* Assess risk to each individual exposed

Aidan: /* Epidemiology */

2020-02-13T20:34:25Z

Epidemiology

← Older revision		Revision as of 20:34, 13 February 2020
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	== Epidemiology ==		== Epidemiology ==
			[[File:Coccidiomycosis_map.png\|thumb\|Distribution of coccidiomycosis]]

	* Found in thermic soils in arid regions		* Found in thermic soils in arid regions

Aidan at 19:41, 15 August 2019

2019-08-15T19:41:55Z

← Older revision		Revision as of 19:41, 15 August 2019
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	* Dimorphic fungus in patients from arid areas in SW US and Mexico, which is mostly asymptomatic but can cause pulmonary disease, and rarely disseminated disease. Also called Joaquin Valley fever.		* Dimorphic fungus in patients from arid areas in SW US and Mexico, which is mostly asymptomatic but can cause pulmonary disease, and rarely disseminated disease. Also called Joaquin Valley fever.

	= Microbiology =		== Microbiology ==

	* Dimorphic fungus with barrel-shaped arthroconidia in the septated hyphal filamentous form		* Dimorphic fungus with barrel-shaped arthroconidia in the septated hyphal filamentous form
	* Coccidiomycosis also caused by ''Coccidioides posadasii'' outside of California		* Coccidiomycosis also caused by ''Coccidioides posadasii'' outside of California

	= Epidemiology =		== Epidemiology ==

	* Found in thermic soils in arid regions		* Found in thermic soils in arid regions
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	* There is a strain with a mutation that can cause aggressive invasive disease in younger adults		* There is a strain with a mutation that can cause aggressive invasive disease in younger adults

	= Pathophysiology =		== Pathophysiology ==

	* Arthroconidia break off of the filamentous form and are inhaled (or inoculated)		* Arthroconidia break off of the filamentous form and are inhaled (or inoculated)
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	* The spherules rupture, releasing the endospores and continuing the cycle		* The spherules rupture, releasing the endospores and continuing the cycle

	= Clinical Presentation =		== Clinical Presentation ==

	* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant		* Variable, from asymptomatic or mild (60%), to symptomatic (40%), to disseminated and fulminant
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	* Symptoms may take weeks to many months to resolve		* Symptoms may take weeks to many months to resolve

	== Desert rheumatism ==		=== Desert rheumatism ===

	* Erythema nodosum		* Erythema nodosum
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	* Arthralgias		* Arthralgias

	== Complications ==		=== Complications ===

	* Chronic pulmonary disease:		* Chronic pulmonary disease:
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	* Extra-pulmonary dissemination (skin, bones, joints, CNS): ≤1%		* Extra-pulmonary dissemination (skin, bones, joints, CNS): ≤1%

	== Risk factors for disseminated disease ==		=== Risk factors for disseminated disease ===

	* Immunosuppression, including HIV/AIDS, pregnancy, TNF inhibitors, corticosteroids, and transplantation		* Immunosuppression, including HIV/AIDS, pregnancy, TNF inhibitors, corticosteroids, and transplantation
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	* High complement fixation titre >1:16		* High complement fixation titre >1:16

	= Differential Diagnosis =		== Differential Diagnosis ==

	* Infectious		* Infectious
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	* Non-infectious		* Non-infectious

	= Diagnosis =		== Diagnosis ==

	* Direct microscopy: typical spherules		* Direct microscopy: typical spherules
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	** Rule out Cryptococcus and TB		** Rule out Cryptococcus and TB

	= Management =		== Management ==

	* Many do not need treatment, as infection is asymptomatic or self-limited		* Many do not need treatment, as infection is asymptomatic or self-limited
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	** Daily therapeutic LP titrated to opening pressure (like crypto)		** Daily therapeutic LP titrated to opening pressure (like crypto)

	== Laboratory Exposure ==		=== Laboratory Exposure ===

	* Evacuate lab, seal lab, call Biosafety Officer on call		* Evacuate lab, seal lab, call Biosafety Officer on call