Coccidioidomycosis ( , kok-sid-ee-oy-doh-my- KOH -sis ), commonly known as " cocci ", " Valley fever ", and " California fever ", " desert arthritic ", and" San Joaquin Valley fever ", is a mammalian fungal disease caused by Coccidioides immitis or Coccidioides posadasii . Coccidioidomycosis is endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah, and northern Mexico.
C. immitis is a dimorphic saprophyte fungus that grows as a mycelium in the soil and produces a spherule form in the host organism. It is located on land in certain parts of the southwest United States, especially in California and Arizona. It is also commonly found in northern Mexico, and parts of Central and South America. C. immitis is inactive during a long dry season, then develops as a mold with long filaments that break into air spores during rain. Spores, known as arthroconidia, are swept into the air by disturbance of the soil, such as during construction, agriculture, or earthquakes. Windstorms can also cause epidemics away from endemic areas. In December 1977 a windstorm in an endemic area around Arvin, CA caused hundreds of cases, including death, in non-endemic areas hundreds of miles away.
Coccidioidomycosis is a common cause of community acquired pneumonia in endemic areas in the United States. Infection usually occurs due to inhalation of arthroconidial spores after soil disturbance. This disease is not contagious. In some cases, the infection may recur or become chronic.
Video Coccidioidomycosis
Signs and symptoms
It is estimated that 60% of people infected with fungi responsible for coccidioidomycosis have at least no symptoms, while 40% will have various possible clinical symptoms. Of those who develop symptoms, primary infection is most commonly breathing, with symptoms resembling bronchitis or pneumonia that recover within a matter of weeks. In endemic areas, coccidioidomycosis is responsible for 20% of community acquired pneumonia cases. Signs and symptoms of recorded coccidioidomycosis include deep feelings of fatigue, fever, cough, headache, rash, muscle aches, and joint pain. Fatigue can last for months after the initial infection. The classic triassic coccidioidomycosis known as "desert rheumatism" includes a combination of fever, joint pain, and erythema nodosum.
Nearly 3% to 5% of infected individuals do not recover from early acute infection and develop chronic infection. These can be chronic lung infections or disseminated infections (affecting tissues lining the brain, soft tissues, joints, and bones). Chronic infection is responsible for most morbidity and mortality. Chronic fibrocavitary disease is manifested by cough, phlegm, fever, night sweats and weight loss. Osteomyelitis, including spinal involvement, and meningitis that can occur several months to years after the initial infection. Severe lung disease can develop in people infected with HIV.
Type
After Coccidioides infection, coccidioidomycosis begins with Valley fever, which is an early acute form. Valley fever may develop into a chronic form and then disseminated coccidioidomycosis. Therefore, Coccidioidomycosis can be divided into the following types:
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- Acute coccidioidomycosis, sometimes described in the literature as primary pulmonary coccidioidomycosis
- Chronic coccidioidomycosis
- Disseminated Coccidioidomycosis, which includes primary skin coccidioidomycosis
Complications
Serious complications can occur in patients who have weakened immune systems, including severe pneumonia with respiratory failure and bronchopleural fistulas that require resection, pulmonary nodules, and possible disseminated forms, in which the infection spreads throughout the body. The disseminated form of coccidioidomycosis can destroy the body, causing skin ulcers, abscesses, bone lesions, swollen joints with severe pain, heart inflammation, urinary tract problems, and inflammation of the lining of the brain, which can cause death.
Maps Coccidioidomycosis
Cause
It must be the first rain to start the early growth cycle of underground mushrooms. In soil (and in agar medium), Coccidioides are present in the form of filaments. It forms hyphae in both horizontal and vertical directions. During prolonged dry periods, cells in the hyphae degenerate to form barrel-shaped cells back and forth (arthroconidia). Arthroconidia is light and carried by air currents. This occurs when soils are often disturbed by tree felling, construction and agriculture. As the population grows, so do all these industries, causing potential cascade effects. The more soil cleared, the more dry the soil, the environmental riper for Coccidioides . These spores can easily be sucked without anyone's knowledge. Upon arriving at the alveoli, they expand into spherules, and internal septations develop. This division of cells is made possible by the optimal temperature in the body. Septations develop and form endospores in the spherule. Rupture of spherules releases these endospores, which in turn repeat the cycle and spread the infection to adjacent tissues within the body of the infected individual. Nodules can form in the lungs around these spherules. When they break, they release their contents to the bronchus, forming thin-walled cavities. These cavities can cause symptoms such as typical chest pain, coughing up blood, and persistent coughing. In individuals with weakened immune systems, the infection can spread through the blood. On rare occasions it can get into the body through a break in the skin, causing an infection.
Diagnosis
The diagnosis of coccidioidomycosis depends on the combination of signs and symptoms of an infected person, findings on radiographic imaging, and laboratory results. The disease is often misdiagnosed as pneumonia acquired from bacterial communities. Fungal infections can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and tissue biopsies by the Papanicolaou method or methenamine Grocott silver staining. This stain can indicate the spherules and the surrounding inflammation.
With certain nucleotide primers, C.immitis DNA can be amplified by polymerase chain reaction (PCR). It can also be detected in cultures with morphological identification or by the use of molecular probes hybridizing with RIM's Cimmitis. C. immitis and C. posadasii can not be distinguished from cytology or symptoms, but only with PCR DNA.
Demonstration of indirect fungal infections can also be achieved by serological analysis of fungal antigens or host IgM or IgG antibodies produced against fungi. Available tests include a test tube-precipitin (TP), complete the fixation test, and enzyme immunoassays. TP antibodies are not found in cerebrospinal fluid (CSF). The TP antibodies were specific and were used as confirmatory tests, while ELISA was sensitive and was used for initial testing.
If the meninges are affected, CSF will show abnormally low levels of glucose in CSF, elevated protein levels in CSF, and lymphocytic pleocytosis. Rarely, CSF eosinophilia is present.
Imaging
Chest X-rays rarely show nodules or cavities in the lungs, but these images usually show pulmonary fluid, pleural effusion, or enlarged lymph nodes associated with the lung. Computed tomography scans from the chest are better able to detect these changes than chest x-ray.
Prevention
Preventing valley fever is a challenge because it is difficult to avoid breathing in the fungus if any, but the public health effects of the disease are very important to understand in areas where the fungus is endemic. Improved surveillance Coccidiodomycosis is the key to readiness in the medical field in addition to improving diagnostics for early infection. There are currently no truly effective preventive measures for people living or traveling through the endemic areas of the Valley of Fever. Recommended precautions include avoiding dust or dirt in the air, but this does not guarantee protection against infection. People in certain jobs may be advised to wear face masks. The use of air filtering in the room also helps, in addition to keeping skin wounds clean and covered to avoid skin infections.
In 1998-2011, there were 111,117 cases of coccidioidomycosis in the US that went into the Verified National Disease Control System (NNDSS). Since many states in the US do not require reporting of coccidioidomycosis, the actual rate may be higher. The United States Centers for Disease Control and Prevention (CDC) called the disease a "silent epidemic" and admitted there was no proven anticoccidio vaccine. Past studies have shown that the cost benefits of a vaccine are most prominent among infants, adolescents and adult immigrants, with negative cost-benefit outcomes among older age groups.
Increasing surveillance and awareness of this disease while medical researchers developing human vaccines can positively contribute to prevention efforts. Research shows that patients from endemic areas who are aware of the disease are likely to request diagnostic tests for coccidioidomycosis. Currently, Meridian Bioscience is producing what is called the EIA test to diagnose the Valley fever, which is somehow known for generating a fair false positive quantity. Currently, the recommended precautions may include protection of exposure-type respirators for people involved in agriculture, construction and others who work outdoors in endemic areas. Dust control measures such as growing grass and soaking the soil, and also limiting exposure to dust storms are recommended for residential areas in endemic areas.
Treatment
Significant diseases develop in less than 5% of those infected and usually occur in those with weakened immune systems. A mild asymptomatic case often does not require any treatment, and symptoms will disappear within a few months. Those who have severe symptoms may benefit from antifungal therapy, which usually takes 3-6 months of treatment. A lack of prospective studies examining antifungal therapy is optimal for coccidioidomycosis.
Overall, oral fluconazole and intravenous amphotericin B are used in progressive or disseminated disease, or in individuals with impaired immune systems. Amphotericin B is used to be the only treatment available, although now there are alternatives, including itraconazole or ketoconazole can be used for minor ailments. Fluconazole is the preferred drug for coccidioidal meningitis, due to penetration into CSF. Intrathecal or intraventricular amphotericin therapy is used if the infection continues after the treatment of fluconazole. Itraconazole is used for cases involving the care of bone and joints of infected patients. Antacungal drugs posaconazole and voriconazole have also been used to treat coccidioidomycosis. Because the valley fever symptoms are similar to the common cold and other respiratory diseases, it is important for public health professionals to be aware of the rise of valley fever and specific diagnosis. Greyhound dogs also often have a fever in the valley, and their treatment regimen involves 6-12 months of ketoconazole, to be drunk with food.
Toxicity
Conventional amphotericin B desoxycholate (AmB: used since 1950 as a primary agent) is known to be associated with an increase in drug-induced nephrotoxicity (renal toxicity) that impairs renal function. Other formulations have been developed such as lipid-soluble formulations to reduce side effects such as proximal tubular cytotoxicity and direct distal. These include liposomal amphotericin B, amphotericin B lipid complex such as Abelcet (brand) amphotericin B phospholipid complex as well as AmBisome Intravenous , or Amphotec Intravenous (Generic, Amphotericin B Cholesteryl Sul) and, amphotericin B colloidal dispersion , all shown to show decreased nephrotoxicity. Which was then ineffective in one study such as amphotericin B desoxycholate having a murine morbidity of 50% versus zero for AmB colloidal dispersion.
The cost of AmB deoxycholate, in 2015, for patients of 70 kilograms (150 pounds) at a dose of 1 mg/kg/day, was about $ 63.80, compared to 5 mg/kg/day AmB liposomal at $ 1318.80, toxic options less accessible.
Epidemiology
Coccidioidomycosis is endemic in the western hemisphere between 40Ã, Â ° N and 40Ã, Â ° S. Ecological niches are characterized by hot summers and mild winters with 10-50 cm annual rainfall. This species is found in alkaline sandy soils, usually 10-30 cm below the surface. In harmony with the mycelium life cycle, events increase with periods of drought after the wet season; This phenomenon, called "growing and exploding", refers to the growth of fungi in wet weather, producing spores propagated by the wind during dry weather. While most of the cases were observed in endemic areas, cases reported outside the area were generally visitors, who contacted the infection and returned to their home areas before it became a symptom.
North America
In the United States, C. Immitis is endemic to southern and central California with the highest presence in the San Joaquin Valley. C. posadassi is most common in Arizona, although it can be found in a wider area ranging from Utah, New Mexico, Texas, and Nevada. An estimated 150,000 infections occur each year, with 25,000 new infections occurring each year. The incidence of coccidioidomycosis in the United States in 2011 (42.6 per 100,000) was almost ten times higher than incidents reported in 1998 (5.3 per 100,000). In the most prevalent areas, the infection rate is 2-4%.
Incidents vary greatly in the west and southwest. In Arizona, for example, in 2007, there were 3,450 cases in Maricopa County, which in 2007 had an estimated population of 3,880,181 for an incident of about 1 in 1,125. In contrast, although southern New Mexico is considered an endemic region, there were 35 statewide cases in 2008 and 23 in 2007, in areas with an estimated population of 1,984,356 in 2008, for an incidence of about 1 in 56,695.
The rates of infection vary widely by region, and although population density is important, so are other unproven factors. Larger construction activity can disrupt the spores in the soil. In addition, the influence of altitude on fungal and morphological growth has not been studied, and altitude can range from sea level to 10,000 feet or higher in California, Arizona, Utah and New Mexico.
In California from 2000 to 2007, there were 16,970 reported cases (5.9 per 100,000 people) and 752 deaths from 8,657 people admitted to hospital. The highest incidence occurred in San Joaquin Valley with 76% of 16,970 cases (12,855) occurring in the area. After the 1994 Northridge earthquake, there was a sudden increase in cases in the quake-stricken area, with speeds of more than 10 initial times.
There was an outbreak in the summer of 2001 in Colorado, away from where the disease was considered endemic. A group of archaeologists visited Dinosaur National Monument, and eight crew members, along with two National Park Service workers diagnosed with Valley fever.
The state prison of California, beginning in 1919, has been severely affected by coccidioidomycosis. In 2005 and 2006, the Pleasant Valley State Prison near Coalinga and Avenal State Prison near Avenal on the west side of the San Joaquin Valley had the highest incidence in 2005, at least 3,000 per 100,000. Designated recipients at Plata v. Schwarzenegger issued an order in May 2013 requiring the relocation of vulnerable populations in the prison. Incidence rates have increased, with rates as high as 7% over 2006-2010. The cost of care and care is $ 23 million in California prisons. A lawsuit filed against the state in 2014 on behalf of 58 inmates stating that the state prison of Avenal and the Pleasant Valley did not take the necessary steps to prevent infection.
Risk factors
There are some populations that have a higher risk of contracting coccidioidomycosis and developing a disseminated version of the disease. Populations with exposure to air arthroconidia working in agriculture and construction have a higher risk. The plague is also associated with earthquakes, storms, and military exercises where the land is disturbed. Historically infection is more likely to occur in men than in women, although this may be linked to work rather than gender-specific. Women who are pregnant and immediately postpartum are at a high risk of infection and dissemination. There is also a relationship between pregnancy stage and disease severity, with third trimester women more likely to develop dissemination. Presumably this is associated with very high hormonal levels, which stimulate the growth and maturation of spherules and subsequent release of endospores. Certain ethnic populations are more susceptible to the spread of coccioidomycosis. The risk of spreading is 175 times greater in the Philippines and 10 times greater in African Americans than non-Hispanic whites. Individuals with weakened immune systems are also more susceptible to disease. In particular, individuals with HIV and diseases that destroy T-cell function. Individuals with pre-existing conditions such as diabetes are also at higher risk. Age also affects the severity of the disease, with more than a third of deaths in the 65-84 age group.
Other animals
Animal infected with Valley fever can not transmit the disease to other animals. In dogs, the most common symptom of coccidioidomycosis is a chronic cough, which can become dry or moist. Other symptoms include fever (in about 50% of cases), weight loss, anorexia, lethargy, and depression. This disease can spread throughout the dog's body, most often causing osteomyelitis (infection of the bone marrow), which causes lameness. Dissemination can cause other symptoms, depending on the infected organ. If the fungus infects the heart or pericardium, the fungus can cause heart failure and death.
In cats, symptoms may include skin lesions, fever, and loss of appetite, with skin lesions being the most common.
Other species in which Valley fever has been found include livestock such as cattle and horses; llama; marine mammals, including sea otters; animal zoos such as monkeys and apes, kangaroos, tigers, etc.; and wildlife originating from geographic areas where fungi are found, such as puma, skunks, and javelina.
History
The first case, then named coccidioidomycosis, was described in 1892 in Buenos Aires by Alejandro Posadas, a medical officer at the Hospital de Classias "JosÃÆ'Â © de San MartÃÆ'n". Posadas form the character of a disease infection after being able to transfer it in laboratory conditions to laboratory animals. In the US, E. Rixford, a physician from San Francisco Hospital, and T. C. Gilchrist, a pathologist at Johns Hopkins Medical School, pioneered early clinical studies of infection. They decided that the causative organism was Coccidia -the protozoan type and named it Coccidioides immitis (resembling Coccidia , not light).
Over the next few decades it became clear that the etiologic agent of the disease originally called Coccidioides infection and then coccidioidomycosis was a fungal pathogen, and coccidioidomycosis was also distinguished from Histoplasmosis and Blastomycosis. Furthermore, [Coccidioides immitis] was identified as the cause of respiratory distress previously described as San Joaquin Valley fever, desert fever, and Valley fever, and serum precipitin test developed by Charles E. Smith capable of detecting acute form of infection. In retrospect, Smith played a major role in both medical research and raised awareness about coccidioidomycosis, especially when he became dean of the School of Public Health at the University of California at Berkeley in 1951.
[Coccidioides immitis] was considered by the United States during the 1950s and 1960s as potential biological weapons. The tension chosen for the investigation is set by the OC military symbol, and the initial hope is for its dissemination as a human being who can not afford it. Medical research suggests that OC may have some deadly effects on the population, and [Coccidioides immitis] is being classified by the authorities as a threat to public health. However, [Coccidioides immitis] was never ignited by public knowledge, and most military research in the mid-1960s was concentrated on the development of human vaccines. Currently, it is not on the US Department of Health and Human Services (HHS) list or the Centers for Disease Control and Prevention from select agents and toxins.
In 2002, Coccidioides posadasii was identified genetically different from [Coccidioides immitis] in spite of their morphological similarity and could also cause coccidioidomycosis.
Research
In 2013, no vaccines are available to prevent infection with Coccidioides immitis or Coccidioides posadasii , but efforts to develop such a vaccine are underway.
Additional images
See also
- Coccidioides
- Coccidioides immitis
- Coccidioides posadasii
- Zygomycosis
- Medical geology
- List of skin conditions
- Thunderhead , a 1998 novel by Douglas Preston and Lincoln Child using mushrooms and diseases as a central plot point.
References
External links
- AS. Centers for Disease Control and Prevention at Coccidioidomycosis
- Medline Plus Entry for Coccidioidomycosis
Source of the article : Wikipedia
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