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Anthony Fossaceca Anthony Nuzzi Swati Vasireddy
Coccidioidomycosis By Team Aspergillus
Coccidioidomycosis Coccidioidomycosis is an infection, usually of the lungs, caused by the fungus Coccidioides immitis/posadasii.
Caused by inhaling spores of the fungus Usually mild, with :lu-‐like symptoms and rashes
http://microbewiki.kenyon.edu/index.php/Coccidioides_immitis Spherule with endospores of Coccidioides immitis. FA stain
lung showing a large fibrocaseous nodule
History of Coccidioidomycosis
Wernicke and Posadas :irst described a case of coccidioidomycosis in 1892 in South America
Two years later Rixford and Gilchrist reported a case in California around 1894-‐96
commons.wikimedia.org/wiki/File:Alejandro_Pos.
History of Coccidioidomycosis
Also known as Valley fever, San Joaquin Valley fever, California disease, and desert fever
The :irst effective therapy Used Amphotericin B in 1957
Etiology/Causative of Coccidioides sp.
Coccidioides immitis (name most commonly used)
Coccidioides posadasii
http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dimorphic_Pathogens/Coccidioides/
Coccidioides immitis/posadasii Difference
Little known about Pathogenicity (pathogen to produce infections)
Morphologically identical Distinguished only by
genetic analysis Rates of growth in the presence of high salt concentrations C. posadasii grows more slowly
Location in the world
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Taxonomy of Coccidioides immits/posadasii
Kingdom: Fungi Phylum: Ascomycota Class: Euascomycetes Order: Onygenales Family: Onygenaceae Genus: Coccidioides
Biology of Coccidioides immitis/posadasii Fungi
Arthroconidia spores typically produced by segmentation of pre-‐existing fungal hyphae
Asexual Spherules (Circular Spores) Asexual Haploid
In sabouraud dextrose agar (25 to 37O C) Grayish initially, later producing white aerial mycelium. With age colonies become tan to brown
Biology of Coccidioides immitis/posadasii Thermal Dimorphic Coccidioides immitis/posadasii
Arthroconidia found within the mycelial (25O C) Thick walled, barrel or cask shaped
Once inhaled by a living organism, arthroconidia develops into thick-‐walled spherule :illed with endospores (37O C)
Endospores are released which causes an infection in the organism • Known as coccidioidomycosis
Life Cycle
http://www.metapathogen.com/coccidioides/
Life Cycle
http://www.cdc.gov/ncidod/EID/vol2no3/kirkland.htm
Ecology of Coccididiode Sp.
C. immitis Located in California’s San Joaquin Valley region
C. posadasii Southwest desert of U.S., Mexico, and S. America
Lives in High summer temperatures and low altitude Dry areas with low rain fall
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Ecology of Coccididiode Sp.
Coccidioides immitis/posadasii Arthroconidia Forms in the soil as mycelium Around 25O C
Spherules (Spherical Spores) Develops infection once inhaled by animal or human 7 to 21 days
Around 37-‐40O C
http://www.doctorfungus.org/thefungi/Coccidioides.htm
Ecology of Coccididiode
http://en.wikipedia.org/wiki/Coccidioidomycosis
Disease Manifestation of Coccidioidomycosis
Disease in humans Men more likely to be infected than women Also, those who are immunocompromised. Such as Aids victims
60% of people who are infected show no symptoms (asymptomatic).
40% symptoms appear 10-‐30 days after exposure
Patients may not show symptoms for 20 or more years
http://www.mycology.adelaide.edu.au/Mycoses/Dimorphic_systemic/Coccidioidomycosis/
Disease Manifestation of Coccidioidomycosis
Symptoms Malaise Myalgia Chest pain Fatigue Erthema multiforme Erythema nodosum Arthralgia Regional lymphadenitis
Common Cold Flu-‐like symptoms Fever Cough Headaches Rash Myalgias Asymptomatic Infuenza-‐like symptoms
Disease Manifestation of coccidioidomycosis
In Animals Life threatening Fever Loss of appetite Loss of energy Swollen joints Swollen lymph nodes Cough Attacks lung
http://www.cfsph.iastate.edu/DiseaseInfo/disease-images.php?name=coccidioidomycosis
Description: Dog lung (Right) and wallaby (Left) kidney. Cross section of lung reveals multifocal to coalescing pale firm areas (granulomas).
Disease Prevention Only method of prevention is to avoid visiting areas where it is found (Impossible) Endemic in Arizona, California, Nevada, New Mexico, Texas, Utah, North Western Mexico, South Africa, and Asia
Stay away from dust storms, Farming, and high construction areas.
Maintain good health and protect yourself from HIV infection.
http://www.abc.net.au/reslib/200804/r237411_957564.jpg http://en.wikipedia.org/wiki/File:Magic_Lipofsky.jpg
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Works Cited http://emedicine.medscape.com/article/297976-overview http://www.absoluteastronomy.com/topics/Coccidioidomycosis http://www.ajronline.org/cgi/reprint/136/2/393.pdf http://www.cdc.gov/ncidod/EID/vol2no3/kirkland.htm https://online.epocrates.com/u/2924558/Coccidioidomycosis/
Basics/Etiology http://www.medicinenet.com/valley_fever/article.htm http://jcm.asm.org/cgi/content/full/38/2/807 http://www.doctorfungus.org/thefungi/Coccidioides.htm http://www.mycology.adelaide.edu.au/
Epidemiology Begins as a respiratory illness May progress to a persistent infection
Disseminated coccidioidomycosis is the most severe form of the disease Often fatal
C. immitis was a potential biological weapon
Epidemiology Mostly restricted to America Currently an endemic disease
Immunocompromised individuals are more susceptible to the disease
Coccidioidomycosis
Virulence Factors The parasitic cell surface glycoprotein Functions as an adhesion
Branching septate hyphae that are 2 to 4m in diameter
production of chitinase and ß-‐glucanase during the transition from the mycelial to parasitic form
Host Response T lymphocytes inhibits the growth of arthroconidia and endospores
Cytokines Antibody Little attention given
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Diagnosis Septum culture is most effective PCR is also used
Primary lung infection is asymptomatic in 60% of individuals The other 40% develop a mild to moderate in:luenza-‐like syndrome 1 to 3 weeks after exposure
Disease management Antifungal therapy Occasional chest radiographs
Biopsy of nonhealing ulcers and lesions
WORKS CITED http://health.utah.gov/epi/fact_sheets/cocci.html http://www.scielo.br/scielo.php?
pid=S0036-46651998000300001&script=sci_arttext http://cmr.asm.org/cgi/content/full/17/4/804 http://www.images.missionforvisionusa.org/anatomy/
2007/02/coccidiodomycosis.html
CASE REPORTS
CASE REPORT 1 37-‐year-‐old female Emergency room complaining of swollen right thumb
Bitten 2 weeks ago by stray cat Whole right hand now erythmetous, swollen, tender
Initial physical examination indicated no problems Admitted to operating room to see hand surgeon Exploratory surgery showed extreme swelling of right arm but minimal purulence
Tissue specimens submitted for culture and staining
CASE REPORT 1 Initial stains showed no organisms
Gram stain for bacteria, Kinyoun stain for mycobacteria, calco:luor white stain for fungi
Histopathology showed only perivascular dermatitis Started on vancomycin and ceftriaxone Condition worsened, taken back to surgery Original cultures showed waxy mold on :ifth day Identi:ied next day as Coccidioides sp. using genus-‐speci:ic ribosomal probe
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CASE REPORT 1 Started on :luconazole Condition improved dramatically Discharged 6 days after admission Serum enzyme immunoassay serology results for Coccidioides IgM and IgG antibodies negative at discharge and at 6 weeks
Remained symptom-‐free, taken off :luconazole after 2 months
CASE REPORT 1 Cat died shortly after biting patient Veterinary pathologist noted pyogranuloma with lots of spherules
Final diagnosis on cat: multifocal granulomatous splenitis and disseminated disease with Coccidioides spp. as the etiologic organisms
Etiologic agents now considered two different species in genus Coccidioides Coccidioides immitis and Coccidioides posadasii
Gaidici, Adriana, and Michael A. Saubolle. "Transmission of Coccidioidomycosis to a Human via a Cat Bite." Journal of Clinical Microbiology 47.2 (2009). ISI Web of Knowledge. Web. <http://apps.isiknowledge.com/full_record.do?product=UA&search_mode=Re:ine&qid=2&SID=2EgAgPNeL9LjNeOHibe&page=1&doc=5&colname=MEDLINE&cacheurlFromRightClick=no>.
CASE REPORT 2 39-‐year-‐old male At routine follow-‐up, complained of swelling in face, prominent veins on chest
2 years before, diagnosed with HIV when presented with Coccidioides pneumonia
Started on :luconazole 41 days later, started highly active antiretroviral therapy (HAART)
CD4 count improved, HIV viral load dropped
CASE REPORT 2 Facial swelling started 27 months after HAART initiation
Chest x-‐ray showed widened mediastinum, right middle lobe
Coccidioides complement :ixation was 1:32 Was 1:8 at time of HIV diagnosis
Underwent core needle biopsy of RML lesion Spherules consistent with Coccidioidomycosis
Fungal culture and acid-‐fast negative
CASE REPORT 2 Underwent VATS to biopsy mediastinal nodes Video-‐assisted thoracoscopic surgery
Nodes demonstrated consistency with Coccidioidomycosis but no evidence of malignancy
Recovered well from surgery, facial swelling resolved
Received 1g Amphotericin B after :inal biopsy
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CASE REPORT 2 Coccidioidomycosis seemed to be cause of SVC problems, but not common :inding Tuberculosis more common infectious agent
First published case of Coccidioides causing SVC syndrome
Mortimer, Roger B., Robert Libke, Babak Eghbalieh, and John F. Bilello. "Immune Reconstitution In:lammatory Syndrome Presenting as Superior Vena Cava Syndrome Secondary to Coccidioides Lymphadenopathy in an HIV-‐infected Patient." Journal of the International Associaton of Physicians in AIDS Care 7.6 (2008). ISI Web of Knowledge. Web. <http://apps.isiknowledge.com/full_record.do?pr oduct=UA&search_mode=Re:ine&qid=10&SID=2E gAgPNeL9LjNeOHibe&page=1&doc=7&colname= MEDLINE&cacheurlFromRightClick=no>.
QUESTION 1
Coccidioide differ in what way?
A. Pathogencity B. Morphology C. Genetic Analysis D. None of the above
QUESTION 2
Coccidioide immitis is most known in what region?
A. Mexico B. S. America C. Off the coast of the Balkan Islands near Michigan
D. California's San Joaquin Valley
QUESTION 3
Coccidioidomycosis begins as a
A. respiratory illness B. digestive illness C. cutaneous infection D. urinary infection
QUESTION 4
Which is not a type of coccidioide?
A. C. immitis B. C. posadasii C. C. Blavens D. C. fumigatus
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QUESTION 5
The :irst effective therapy for Coccidioidomycosis was
A. Amphotericin B B. Fluconazole C. Itraconazole D. Vancomycin