ADAM Health Encyclopedia

Coccidioidomycosis

Definition

Coccidioidomycosis is a disease caused by the spores of the fungus Coccidioides immitis.

Alternative Names

Causes

Infection is caused by inhalation of the spores of the fungus, Coccidioides immitis, which is often found in desert regions. About 60% of infections cause no symptoms and are only recognized later by a positive coccidioidin skin test.

In the remaining 40% of cases, symptoms range from mild to severe. People with a compromised immune system tend to have more serious infections. Individuals with AIDS are at higher risk for pulmonary (lung) coccidioidomycosis, as well as for the disseminated (spread to many body systems) and cutaneous (skin) forms of the disease.

The disease can have an acute, chronic, or disseminated form. Acute pulmonary coccidioidomycosis is almost always mild, with few or no symptoms, and resolves without treatment. The incubation period is 7 to 21 days.

Acute coccidioidomycosis is rare. In any given year, about 3% of people who live in an area where coccidiomycosis is commonly seen will develop the disease.

Chronic pulmonary coccidioidomycosis can develop 20 or more years after initial infection which may not have been recognized, diagnosed, or treated at the time. Infections (lung abscesses) can form and rupture releasing pus (empyema) between the lungs and ribs (pleural space). This disorder is even less common than the acute form, however.

In disseminated disease, spread of infection to the bones, lungs, liver, meninges, brain, skin, heart, and pericardium (sac around the heart) may take place. Meningitis occurs in 30-50% of cases of disseminated disease. The course of the disease may be rapid for immunosuppressed patients.

Symptoms

Any of the following may be symptoms:

• Cough
• Chest pain, varies from mild sense of constriction to severe
• Fever
• Chills
• Night sweats
• Headache
• Muscle stiffness
• Muscle aches
• Joint stiffness
• Neck stiffness or shoulder stiffness
• Rash, may be painful, red, on lower legs (erythema nodosum)
• Blood-tinged sputum
• Loss of appetite
• Weight loss
• Wheezing
• Sweating, excessive
• Change in mental status
• Sensitivity to light

• Joint swelling
• Joint pain
• Arthritis
• Ankle, feet, and leg swelling

Exams and Tests

• Sputum smear (KOH test)
• Sputum culture
• Serum coccidioides complement fixation titer
• CBC with differential
• Chest x-ray
• Coccidioidin or Spherulin skin test

Treatment

The acute disease almost always goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.

Disseminated or severe disease should be treated with amphotericin B, ketoconazole, fluconazole, or itraconazole.

Outlook (Prognosis)

The outcome in acute disease is likely to be good. With treatment, for chronic or severe disease, the outcome is usually good (although relapses may occur). People with disseminated disease have a high death rate.

Possible Complications

• Pleural effusion
• Relapse of infection
• Spread of the infection throughout the body
• Complications from medications. In particular, amphotericin B may cause fever, chills, and nausea while it is being given, and may cause abnormal kidney tests after many doses.

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms of coccidioidomycosis develop.

Prevention

General maintenance of good health will limit the disease to a benign pulmonary form. Prevention of AIDS or other causes of damage to the immune system will generally prevent the more severe forms of the disease.

Galgiani JN, Ampel NM, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Practice guidelines for the treatment of coccidioidomycosis. Clin Infect Dis. April 2000;30:658-661.

Chiller TM. Coccidioidomycosis. Infect Dis Clin North Am. 2003; 17(1): 41-57, viii.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 5th ed. London, UK: Churchill Livingstone; 2000:2746-2755.

Galgiani JN, Ampel N, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41:1217-23.