1/276. A fluffy white traveller: imported Coccidiodes immitis infection in an Australian tourist. Pulmonary coccidioidomycosis is a rare cause of pulmonary nodules and respiratory infection in travellers to endemic areas. An Australian tourist suffered an acute respiratory illness while on holiday in mexico. She subsequently developed erythema nodosum and was noted to have a left pulmonary nodule on chest X-ray after return to australia. The diagnosis of coccidioides immitis infection was established by histology and culture of the resected lung lesion. The patient made an uneventful recovery and received one month of therapy with ketoconazole. culture of the fungus took place under controlled Class 3 conditions. An unusual fungal infection in australia, coccidioidomycosis poses special risks to staff of microbiology laboratories. ( info) |
2/276. Reactivation of coccidioidomycosis in a fit American visitor. The case history is presented of an American visitor, known to have had primary coccidioidomycosis previously, who became very unwell during a visit to the UK. Despite consideration of reactivation of coccidioidomycosis from the outset, other pathogens were identified while coccidioides immitis was not initially, leading to a delay in treatment. ( info) |
3/276. The first imported case of pulmonary coccidioidomycosis in korea. coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection. ( info) |
4/276. coccidioidomycosis--the airborne assault continues: an unusual presentation with a review of the history, epidemiology, and military relevance. Despite remarkable advances in detection and therapy, coccidioidomycosis remains a persistent threat to military troops deployed in endemic areas. pregnant women, immunocompromised hosts, and dark-skinned persons, particularly those of Filipino, African, Hispanic or Asian ancestry, are at greatest risk for disseminated coccidioidomycosis. The ethnically diverse military forces have susceptible active duty and reserve members stationed at or temporarily trained on bases located in endemic areas for coccidioides immitis. Although the vast majority of infections with this organism are subclinical, unusual patterns of dissemination pose a diagnostic challenge. The military physician may be tasked with recognizing acute non-specific symptoms as well as bizarre, occult manifestations of coccidioidomycosis. We present a case of disseminated coccidioidomycosis in an active duty Caucasian male who presented with a right shoulder mass. Our patient is atypical in that he had disseminated disease although immunocompetent and Caucasian. Another unusual feature is that the mass was not preceded or accompanied by any other symptoms. We could find only two other reported cases of coccidioidomycosis presenting as a soft tissue mass, both in African-American patients. The epidemiology and history of coccidioidomycosis will be reviewed, with an emphasis on military populations. The insidious nature of coccidioidomycosis, the importance of early detection and treatment in decreasing morbidity and mortality, and the presence of large numbers of military members in the endemic areas make the lessons of this case particularly relevant for all flight surgeons. ( info) |
| infection due to coccidioides immitis usually begins in the lungs. Despite the initial pulmonary portal of entry, endotracheal and endobronchial coccidioidomycosis has rarely been described. Since the introduction of fiberoptic bronchoscopy and the AIDS epidemic, more C. immitis lesions of the large airways have been noted. We present data on 38 cases of coccidioidomycosis of the airways, including 6 cases detailed from our own experience and 32 from the literature. Direct infection of the airways (28 cases) is a more common mechanism of airways disease than is erosion into the airways from a lymph node (5 cases). Bronchoscopic findings vary and may show mucosal involvement or intrinsic obstruction. Endotracheal and endobronchial disease is not a self-limited disease and requires antifungal therapy. Disseminated disease in these patients is common. coccidioidomycosis must be considered in the differential diagnosis of airway pathology. ( info) |
6/276. Constrictive pericarditis due to coccidiomycosis. Coccidiomycosis is a fungal infection that rarely causes cardiac disease. Constrictive pericarditis in the setting of disseminated coccidiomycosis can be fatal, despite antifungal therapy and pericardiectomy. We report on a patient with constrictive pericarditis due to localized infection by coccidioides immitis. The patient underwent successful surgical pericardiectomy and antifungal chemotherapy, and remains well 1 year later. ( info) |
| We describe two cases of disseminated coccidioidomycosis that were complicated by fatal subarachnoid hemorrhage. In the first case, a left middle cerebral artery aneurysm and long-segment vasculitis occurred. In the second case, MR imaging revealed an enlarging coccidioidal granuloma at the tip of the basilar artery, and the artery subsequently ruptured. Fatal intracranial hemorrhage is a rare complication of disseminated coccidioidomycosis. ( info) |
8/276. Disseminated coccidioidomycosis. The role of cytology in multidisciplinary clinical approach and diagnosis. A case of clinically unsuspected disseminated coccidioidomycosis diagnosed by different cytologic approaches and confirmed by mycological culture is reported. An African-American man presented with a clinical picture of pneumonia not responding to antibiotics. He subsequently developed a large neck mass and was found to have mediastinal and hilar adenopathy highly suspicious of a neoplastic process. Fine needle aspiration biopsy of the neck mass, followed by flexible bronchoscopy, was performed. Various cytologic approaches and techniques in rapid diagnosis of suspicious masses are discussed. ( info) |
| BACKGROUND: Of the 13 reported cases of hypercalcemia associated with fungal infection, 1 was caused by cryptococcus neoformans and probably mediated by increased levels of 1,25-dihydroxyvitamin D [1,25(OH)2D]. Eight others were associated with coccidioides immitis, of which only 2 had measured 1,25(OH)2D levels; in both, they were diminished. We report a patient with human immunodeficiency virus infection and simultaneous C. immitis and C. neoformans pneumonia and C. immitis fungemia associated with hypercalcemia. methods: Consecutive measurements of serum total and ionized calcium, phosphorous, blood urea nitrogen, creatinine, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrp) and albumin were performed over a period of 46 months. RESULTS: While the patient was hypercalcemic, intact serum PTH and PTHrp were undetectable, serum 25(OH)D levels were normal, and serum 1,25(OH)2D levels were in the high normal range. Successful treatment of the C. immitis and C. neoformans infections resulted in resolution of the hypercalcemia and increase of PTH and PTHrp to the normal range. CONCLUSION: In some patients with hiv infection, coincident hypercalcemia, and severe fungal infection, the responsible factor may be 1,25(OH)2D. Although total serum levels of this compound may not be frankly elevated, they are inappropriately high for the circumstances. Free 1,25(OH)2D levels should be determined in this situation. ( info) |
| To our knowledge we report the first case of meningitis from coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency. ( info) |