Download COCCIDIOIDOMYCOSIS: WHAT YOU NEED TO KNOW

SJS Dec-03
COCCIDIOIDOMYCOSIS: WHAT YOU NEED TO KNOW
Take home points:
1. The most common clinical presentation in diagnosed cases of coccidioidomycosis is acute or subacute
pneumonic illness.
2. Cocci can be diagnosed by biopsy, culture, or serology. Skin testing is unreliable.
3. No isolation necessary, but specimens can be infectious to lab personnel.
4. Definitely treat patients who have disseminated disease, are immunocompromised, or have meningitis
Microbiology and epidemiology:
• Organism mainly present in Western and Southwestern U.S.
• Virtually no human to human transmission, so no isolation necessary
• Remember that human specimens can pass into saprophtic cycle in the lab and are very infectious.
Always warn the lab if cocci is a possibility.
What is the natural history of cocci infection?
• Of the estimated 100,000 infections per year, one-half to two-thirds are subclinical, and most patients
with these infections are protected from second primary infections.
• The most common clinical presentation in diagnosed cases of coccidioidomycosis is acute or subacute
pneumonic illness.
• Approximately 5 to 10 percent of infections result in residual pulmonary sequelae, usually nodules or
peripheral thin-walled cavities.
• An even smaller proportion of all infections, perhaps 0.5 to 1.0 percent, result in illnesses related to
chronic pulmonary or extrapulmonary infection.
• Approximately one-third of patients treated for extrapulmonary cocci relapse.
How does disseminated infection present?
• More common in men, immunocompromised hosts (HIV and cancer patients), pregnant women
• African Americans and Filipinos especially prone to disseminated disease
• Disseminated disease affects: bones & joints, skin (usually wartlike nodules; also look for E. nodosum),
Meningitis
How is cocci diagnosed?
• Biopsy: presence of spherules in tissue is pathognomonic
• Culture: remember, this is infectious to lab personnel
• Serology: IgM elevated in 75% of people w/primary infection, IgG develops later and disappears
w/resolution of disease
Do you have to treat cocci?
• Primary respiratory infection in competent hosts - treatment is controversial
• Meningitis, disseminated disease, pulmonary disease in immunocompromised hosts: must treat with
antifungals
For more information and resources developed by UCSF medical housestaff,
please browse the following links:
UCSF Department of Medicine, Housestaff Website:
• Resources and information for our housestaff
• Location: http://medicine.ucsf.edu/housestaff/
UCSF Department of Medicine Hospitalist Handbook:
• Available free of charge for download to PDA
• Updated annually and written by UCSF medical residents
• Location: http://medicine.ucsf.edu/housestaff/handbook/
UCSF Chief Medical Residents’ Cover Sheets:
• Covering a wide array of topics that were discussed at morning report
• Location: http://medicine.ucsf.edu/housestaff/Chiefs_cover_sheets/