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Coccidioidomycosis - disseminated

Definition

Disseminated coccidioidomycosis is a fungal infection that spreads through the bloodstream and involves many organs.

Alternative Names

Coccidioidomycosis - systemic

Causes, incidence, and risk factors

Coccidioidomycosis is 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.

Most acute infections cause no symptoms and are only recognized by a positive coccidioidin skin test. Other times, the 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.

The following increases your risk of disseminated coccidioidomycosis:

• Diabetes
• Immunosuppression such as that caused by HIV infection
• Pregnancy
• Traveling to or living in southwestern deserts of the United States

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

Tests that may be done include:

• CBC with differential
• Chest x-ray
• Coccidioidin skin test
• KOH test
• Serum coccidioides complement fixation titer
• Sputum culture

A biopsy of tissue may be done to determine the area of disseminated disease:

• Bone marrow biopsy
• Liver biopsy
• Open lung biopsy
• Skin lesion biopsy

A neurological examination may show abnormalities.

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.

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

Galgiani JN, Ampel NM, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Practice guidelines for the treatment of coccidioidomycosis. Clin Infect Dis. April 2000;30:658-661.

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.

Galgiani JN, Ampel N, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41:1217-23.

Review Date:8/6/2007
Reviewed By:D. Scott Smith, MD., MSc., DTM., Prof. Medical Microbiology & Immunology, Dept. of Human Biology, Stanford Univ. School of Medicine, Stanford, CA. Review provided by VeriMed Healthcare Network.

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