Coccidioidomycosis - acute pulmonary

Definition

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

Causes

Coccidioides infection begins in the lungs, following inhalation of the spores. About 60% of infections resolve without ever causing symptoms and are only recognized by a positive coccidioidin skin test.

In the remaining 40% of infections, symptoms range from mild (cold-like or flu-like) to severe (pneumonia). (See coccidioidomycosis.) In less than 1% of infections, widespread disease occurs when the fungus spreads from the lungs through the blood stream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.

Individuals of African or Philippine descent, and people with weakened immune systems due to AIDS, diabetes, or immunosuppressive medications, may develop more serious infections. Occasionally the acute infection may develop into a chronic pulmonary (lung) disease or can reactivate after a long latent period.

A history of travel to an endemic region is the key to suspecting coccidioidal infection. Arizona, California (especially San Joaquin Valley), and -- to a lesser extent -- western Texas, are endemic regions in the USA.

References

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.