Coccidioidomycosis

Demosthenes Pappagianis, M.D., Ph.D.

University of California, Davis

November 2011

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Pleasant Valley SP 18 6 8 13 6 18 33 44 62 71 41 37 357 4647 7682Avenal SP 5 3 3 4 7 10 9 41 49 52 27 6 216 5723 3774Cal SP, Corcoran 4 2 1 1 0 2 1 1 4 5 4 3 28 4876 574Cal Men's Colony, San Luis Obispo 1 0 2 1 0 2 0 0 4 6 5 2 23 6139 375Cal SP, Los Angeles Co, Lancaster 3 0 1 0 3 5 3 0 2 2 3 0 22 4356 505Kern Valley SP 0 3 1 1 1 0 1 4 3 4 1 0 19 4663 407Cal Corr Ctr, Susanville 0 0 0 1 0 0 0 1 3 1 1 0 7 5460 128Cal Corr Inst, Tehachapi 2 0 0 0 0 0 0 0 1 0 3 1 7 5519 127Cal SATF and SP, Corcoran 0 1 1 0 1 0 0 0 1 1 2 0 7 6082 115Corr Training Fac, Soledad 1 2 0 0 0 0 2 1 0 0 0 0 6 6538 92Mule Creek SP 2 0 0 0 0 2 0 1 0 0 0 1 6 3523 170Cal Rehab Ctr, Norco 0 0 0 2 0 0 1 0 0 0 1 0 4 4132 97RJ Donovan Corr Fac, San Diego 2 0 0 0 0 0 0 2 0 0 0 0 4 4369 92Sierra Conserv Ctr, Jamestown 0 0 0 0 0 0 1 1 0 2 0 0 4 5314 75Deuel Vocational Inst, Tracy 0 0 1 0 0 0 0 0 0 2 0 0 3 3785 79Cal Medical Fac, Vacaville 1 0 1 0 0 0 0 0 0 0 0 0 2 2737 73High Desert SP, Susanville 0 0 1 0 0 0 0 0 0 0 0 1 2 4128 48Cal Inst for Women, Corona 0 0 0 0 0 1 0 0 0 0 0 0 1 2071 48Cal SP, Calipatria 0 0 0 0 0 0 0 0 0 1 0 0 1 4153 24Cal SP, San Quentin 0 0 0 0 0 0 0 0 0 0 1 0 1 4983 20Cal SP, Solano 0 1 0 0 0 0 0 0 0 0 0 0 1 5022 20Chuckwalla Valley SP 0 0 0 0 0 0 0 0 1 0 0 0 1 3159 32Valley SP, Chowchilla 0 0 0 0 0 0 0 0 0 0 0 0 0 3296 0

Totals: 39 18 20 23 18 40 51 96 130 147 89 51 722 104675 14559

Coccidioidal Infections for 2010 in California State Prisons

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SComparing Rainfall to Coccidioidal

Infections at Two Prisons

Coalinga Rainfall Pleasant Valley SP Avenal SP

New Coccidioidomycosis California Correctional Institutions (CCI)

January – September 2011(UC Davis Coccidioidomycosis Serology Lab)

CCI PVSP Avenal CA State

Month Monthly cases

Year total

Monthly cases

Year total

Monthly cases

Year total

Monthly cases

Year total

Jan 73 73 38 38 24 24 413 413

Feb 42 114 19 57 15 39 272 685

Mar 50 165 22 79 21 60 288 973

Apr 38 203 23 102 9 69 295 1268

May 38 241 21 123 13 82 308 1576

Jun 44 285 20 143 14 96 280 1856

Jul 39 324 16 159 16 112 366 2222

Aug 75 399 36 195 28 140 243 2465

Sep 97 496 39 234 45 185 139 2604

Domingo Escurra -First patient with

Coccidioidomycosis (1892)

Domingo Escurra

Joao SilveiraSecond case, recognized in

California(1894)

Coccidioidomycosis - California Endemic

Areas

Coalinga

Soledad

Paso RoblesAvenal

Calif. Men’s Colony

Dye Creek

Corcoran

OtayTecate

Archeology students - California

Transmission of Coccidioidomycosis Human to Human CASE

SOURCE

OUTCOME

REFERENCE

Mortician abraded skin of finger while embalming

Expired patient with disseminated coccidioidomycosis

Spread from finger to epitrochlear and axillary lymph nodes survived no therapy

Wilson et al., 1953

House staff (3), nurses (3) Patient with disseminated coccidioidomycosis of knee; organism grew on and dispersed from plaster of Paris cast dispersing arthroconidia

Survived; none disseminated Eckmann et al., 1964

Neonate Mother with coccidioidomycosis of endometrium and cervix

Mother survived, infant died Bernstein et al., 1981

Neonates (twins) Mother with disseminated disease, transplacental

Mother died, infants died Shafai, 1978

Neonate Mother with disseminated coccidioidomycosis of cervix of uterus infected amniotic fluid

Human with transplanted lung

Donor with pulmonary coccidioidomycosis Survived

Larwood, 1962

Tripathy et al., 2002

Human with transplanted kidney Human with transplanted liver

Donor with (unknown) prior disseminated coccy

Fatal

Fatal

Wright et al., 2003“ “

Human with transplanted lung

Donor with quiescent coccidioidomycosis of lungs

Fatal Miller et al., 2004

Infant died; mother survived 5 years

Female with pelvic/ abdominal coccy

Husband’s semen – artificial insemination

Living

H. Chope

1929

Coccidioidal Erythema Nodosum

( Pappagianis 1998)

Night sweats,Anorexia

Coccidioidomycosis - Spectrum of Disease

Woman with Chronic Coccidioidal Cavity – Right Lung

Mannose binding lectin?

Time to Dissemination

Sites involved in disseminated coccidioidomycosis

Fatal, autopsied series Survivors ___________________________________________________________________________________

Forbus and Huntington, Sievers Total Sievers Bestebreurtje et al. (1946) (1967) (1974) (1974)

Number of Patients: 50 131 20 201 16 % % % % % Lung 86 86 60 84 25 Spleen 70 51 25 53 0 Liver 60 45 35 48 0 Kidney 60 35 48 41 0 Skin &Subcut. 64 21 0 29 31 Bone 48 16 22 22 13 Leptomeninges 36 *63 **55 55 13 Adrenal 32 17 20 21 0 Heart (pericardium), pancreas, psoas and retroperitoneal, thyroid, prostate, larynx, scrotum, optic nerve, bladder, penis, placenta, parotid gland, tongue, mastoid bone, periosteum of orbit. ______________

*36 or 27% with solitary meningitis

Coccidioidal Basilar Meningitis

H. Einstein

CSF compartments

?

,(-) skin tests