Coccidioidomycosis - acute pulmonary Health Article

Definition

Acute pulmonary coccidioidomycosis is a lung infection caused by breathing in spores of Coccidioides immitis or Coccidioides posadasii, fungi found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

Causes, incidence, and risk factors

Coccidioides infection begins in the lungs after a person breathes in the spores.

Those who may develop more serious infection include:

• People of African or Philippine descent
• Those with weakened immune systems due to AIDS, diabetes, or medications that suppress the immune system

Occasionally the infection may develop into a long-term (chronic) lung disease or can reactivate after a long latent period.

Traveling to an area where these fungi are found is a risk for coccidioidal infection. Areas in the U.S. include Arizona, California (especially the San Joaquin Valley), and western Texas.

Symptoms

About 60% of infections get better without ever causing symptoms. In the remaining 40% of infections, symptoms range from mild (cold-like or flu-like) to severe (pneumonia).

In less than 1% of infections, the fungus spreads from the lungs through the bloodstream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.

If they occur, symptoms may include:

• Chest pain (varies from mild to severe)
• Chills
• Cough
• Fever
• Headache
• Joint stiffness
• Lymph node swelling
• Muscle aches
• Muscle stiffness
• Night sweats
• Rash, may be painful, red lumps, on lower legs (erythema nodosum)
• Sputum or phlegm
• Weight loss

See also:

• Coccidioidomycosis
• Skin lesion of coccidioidomycosis

Signs and tests

• Biopsy of lymph node or lung (often done with bronchoscopy)
• Blood test for antibodies to the fungus
• Bronchoscopy with lavage
• Complete blood count (CBC)
• Sputum smear (KOH test or Papanicolaou stain)

Treatment

The acute disease usually goes away without treatment. Your health care provider may recommend bedrest and treatment of flu-like symptoms until your fever disappears.

In severe forms of the disease (for example, disseminated coccidioidomycosis), you may need antifungal treatment with amphotericin B, fluconazole, or itraconazole. The best length of treatment with these medications has not been determined.