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Section 3. Summaries of Infectious Diseases
Coccidioidomycosis
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
The primary infection is acquired by the respiratory route and is asymptomatic or self-limited in 60% of children. Symptomatic disease can resemble influenza or community-acquired pneumonia, with malaise, fever, cough, myalgia, headache, and chest pain. Diffuse erythematous maculopapular rash, erythema multiforme, erythema nodosum, and/or arthralgia commonly occur and can be the only clinical manifestations in some children. Chronic pulmonary lesions are rare, but up to 5% of infected people develop asymptomatic pulmonary radiographic residua (eg, cysts, coin lesions). Nonpulmonary primary infection is rare, usually follows trauma, and includes cutaneous lesions or soft tissue infections with associated regional lymphadenitis.
Disseminated infection is rare, occurring in fewer than 1% of infected people; common sites of dissemination include skin, bones and joints, central nervous system (CNS), and lungs. Dissemination to one or more sites is more common in infants than older children and adults. Meningitis almost invariably is fatal if untreated. Congenital infection is rare.
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ETIOLOGY
Coccidioides species are dimorphic fungi. In soil, Coccidioides organisms exist in hyphal phase. Infectious arthroconidia (ie, spores) produced from hyphae become airborne, infecting the host after inhalation or inoculation. In tissues, arthroconidia enlarge to form spherules; mature spherules release endospores that develop into new spherules and continue the tissue cycle. Using molecular markers, the genus Coccidioides is now divided into 2 species: Coccidioides immitis, confined geographically mainly to California, and Coccidioides posadasii, encompassing the remaining areas of the fungus’ distribution within the southwestern United States, northern Mexico, and areas of Central and South America.
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EPIDEMIOLOGY
Coccidioides species is found in soil extensively and is endemic in the southwestern United States, including California, Arizona, New Mexico, Texas, southern Nevada, and Utah; northern Mexico;
Related Article
Red Book 2009 2009: 772.