Coccidioidomycosis: Difference between revisions
(Created page with "==Background== *Fungal infection caused by Coccidioides immitis and C posadasii *Organisms found in soil in arid climates of southwestern US and nearby areas *Transmitted by i...") |
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*Organisms found in soil in arid climates of southwestern US and nearby areas | *Organisms found in soil in arid climates of southwestern US and nearby areas | ||
*Transmitted by inhalation of airborne spores | *Transmitted by inhalation of airborne spores | ||
*Also known as Valley Fever | |||
==Clinical Features== | ==Clinical Features== | ||
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*Most commonly affects lungs | *Most commonly affects lungs | ||
*Mild ILI 1-4 weeks after exposure | *Mild ILI 1-4 weeks after exposure | ||
**Fever | **[[Fever]] | ||
**Sore throat | **[[Sore throat]] | ||
**Cough | **Cough | ||
**Headache | **[[Headache]] | ||
**Fatigue | **Fatigue | ||
**Pleuritic chest pain | **Pleuritic chest pain | ||
*More severe presentation | *More severe presentation | ||
**Fever | **[[Fever]] | ||
**Arthralgias | **[[Arthralgias]] | ||
**Erythema nodosum or erythema multiforme | **[[Erythema nodosum]] or [[erythema multiforme]] | ||
**Chest pain | **[[Chest pain]] | ||
*Rarely, respiratory failure | *Rarely, respiratory failure | ||
*Disseminated disease, more common in immunosuppressed | *Disseminated disease, more common in immunosuppressed | ||
**Dramatic sweats | **Dramatic sweats | ||
**Dyspnea at rest | **Dyspnea at rest | ||
**Fever | **[[Fever]] | ||
**Weight loss | **Weight loss | ||
**50% develop meningitis | **50% develop [[meningitis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Acute respiratory distress syndrome | *[[Acute respiratory distress syndrome]] | ||
*Blastomycosis | *[[Blastomycosis]] | ||
*Enteropathic arthropathies | *Enteropathic arthropathies | ||
*Eosinophilic | *[[Eosinophilic pneumonia]] | ||
*Histoplasmosis | *[[Histoplasmosis]] | ||
*Lung abscess | *[[Lung abscess]] | ||
*Lung cancer | *Lung cancer | ||
*Lymphoma | *[[Lymphoma]] | ||
*Myelophthisic anemia | *Myelophthisic anemia | ||
*Old granuloma | *Old granuloma | ||
*Paracoccidioidomycosis | *[[Paracoccidioidomycosis]] | ||
*Pericarditis (acute or chronic) | *[[Pericarditis]] (acute or chronic) | ||
*Pneumocystis jiroveci pneumonia | *[[Pneumocystis jiroveci pneumonia]] | ||
*Sarcoidosis | *[[Sarcoidosis]] | ||
*Solitary pulmonary nodule | *Solitary pulmonary nodule | ||
*TB | *[[TB]] | ||
==Workup== | ==Workup== | ||
*Basic workup | *Basic workup | ||
**Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%) | **Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%) | ||
**Elevated ESR | **Elevated ESR | ||
**CXR | **CXR | ||
**LP if suspect meningitis | **[[LP]] if suspect [[meningitis]] | ||
*Special testing | *Special testing | ||
**Immunoglobulin testing | **Immunoglobulin testing | ||
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==Treatment== | ==Treatment== | ||
*Often self-limited mild disease not requiring treatment | *Often self-limited mild disease not requiring treatment | ||
*Azoles first line | *[[Azoles]] first line | ||
*Treatment options | *Treatment options | ||
**Itraconazole - 200 mg 2-3 times/day orally | **[[Itraconazole]] - 200 mg 2-3 times/day orally | ||
**Fluconazole - 400-800 mg/day orally or IV | **[[Fluconazole]] - 400-800 mg/day orally or IV | ||
**Ketoconazole - 400 mg/day orally | **[[Ketoconazole]] - 400 mg/day orally | ||
**Amphotericin B deoxycholate - 0.5-1.5 mg/kg/day IV | **[[Amphotericin B]] deoxycholate - 0.5-1.5 mg/kg/day IV | ||
**Lipid formulations of amphotericin B - 2-5 mg/kg/day IV | **Lipid formulations of amphotericin B - 2-5 mg/kg/day IV | ||
Revision as of 07:04, 11 January 2015
Background
- Fungal infection caused by Coccidioides immitis and C posadasii
- Organisms found in soil in arid climates of southwestern US and nearby areas
- Transmitted by inhalation of airborne spores
- Also known as Valley Fever
Clinical Features
- Often asymptomatic
- Most commonly affects lungs
- Mild ILI 1-4 weeks after exposure
- Fever
- Sore throat
- Cough
- Headache
- Fatigue
- Pleuritic chest pain
- More severe presentation
- Rarely, respiratory failure
- Disseminated disease, more common in immunosuppressed
- Dramatic sweats
- Dyspnea at rest
- Fever
- Weight loss
- 50% develop meningitis
Differential Diagnosis
- Acute respiratory distress syndrome
- Blastomycosis
- Enteropathic arthropathies
- Eosinophilic pneumonia
- Histoplasmosis
- Lung abscess
- Lung cancer
- Lymphoma
- Myelophthisic anemia
- Old granuloma
- Paracoccidioidomycosis
- Pericarditis (acute or chronic)
- Pneumocystis jiroveci pneumonia
- Sarcoidosis
- Solitary pulmonary nodule
- TB
Workup
- Basic workup
- Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%)
- Elevated ESR
- CXR
- LP if suspect meningitis
- Special testing
- Immunoglobulin testing
- Culture
- PCR testing
- Skin testing
Treatment
- Often self-limited mild disease not requiring treatment
- Azoles first line
- Treatment options
- Itraconazole - 200 mg 2-3 times/day orally
- Fluconazole - 400-800 mg/day orally or IV
- Ketoconazole - 400 mg/day orally
- Amphotericin B deoxycholate - 0.5-1.5 mg/kg/day IV
- Lipid formulations of amphotericin B - 2-5 mg/kg/day IV
Sources
emedicine