Coccidioidomycosis - disseminated

Definition

Coccidioidomycosis is an 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. The infection spreads through the bloodstream and involves many organs.

Causes, incidence, and risk factors

Coccidioidomycosis is caused by breathing in the spores of a fungus in desert regions. About 60% of acute infections cause no symptoms and are only recognized by a positive coccidioidin skin test. In the remaining 40%, symptoms range from mild to severe.

In the disseminated form of the disease, the infection may spread to the bones, lungs, liver, brain, skin, heart, and pericardium (sac around the heart).

Meningitis occurs in 30 - 50% of cases of disseminated disease. Immunodeficient (immunosuppressed) people -- including those with HIV infection, people with diabetes, and pregnant women of any race -- are more prone to the disease. Recent travel to or residence in southwestern deserts of the U.S. is a risk factor.

Symptoms

• Cough
• Fever
• Chills
• Headache
• Muscle stiffness
• Muscle aches
• Neck stiffness or shoulder stiffness
• Change in mental status
• Sensitivity to light

Additional symptoms that may be associated with this disease:

• Joint swelling
• Joint pain
• Skin reaction (erythema nodosum)
• Arthritis
• Ankle, feet, and leg swelling

Signs and tests

• Sputum smear (KOH test)
• Sputum culture
• Serum coccidioides complement fixation titer
• Coccidioidin skin test
• CBC with differential
• Chest x-ray
• Biopsy of tissue in area of disseminated disease
  • Bone marrow biopsy
  • Liver biopsy
  • Open lung biopsy
  • Skin lesion biopsy
• Changes in neurological examination

Treatment

Bed rest and improved nutrition are recommended. Antifungal drugs are prescribed to treat the infection.

Expectations (prognosis)

People with disseminated disease have a high death rate. Death may be rapid for immunosuppressed patients.

Complications

This can be a fatal disorder.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of disseminated coccidioidomycosis.

Prevention

General maintenance of good health will limit the disease to a harmless lung illness. Prevention of AIDS or other causes of impaired immune system will generally prevent the more severe forms of the disease.

References

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.

Illustrations

Disseminated coccidioidomycosis

Fungus

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Coccidioidomycosis - systemic