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Coccidioidomycosis

Definition

Coccidioidomycosis is a chronic systemic mycosis, endemic in the USA. Central America, and South America.

Etiology

Coccidioides immitis, a dimorphic fungus, is the causative organism.

Main Clinical Features

There are five clinical forms of the disease: a) acute pulmonary, b) chronic pulmonary, c) disseminated focal, d) disseminated widespread, and e) meningitis. Oral lesions develop in disseminated infection, which commonly occurs in patients with AIDS or in immunocompromised patients.

Oral Lesions

These present as vegetating ulcers with irregular peripheries. The palate, tongue, and gingiva are more frequently affected.

Disseminated Widespread Form

Fever, malaise, anorexia, cough, chest pain, weight loss, and lymphadenopathy are common signs and symptoms. With time, lesions develop in the bone, joints, skin, subcutaneous tissues, meninges, and other sites.

Diagnosis

Smear, culture, and biopsy are very useful diagnostic tools. Serologic tests are also helpful.

Differential Diagnosis

•Paracoccidioidomycosis

•Other systemic mycoses

•Squamous cell carcinoma

•Tuberculosis

•Syphilis

•Non-Hodgkin lymphoma

•Leishmaniasis

Treatment

Basic Guidelines

These are as for the other systemic mycoses.

Suggested Therapies

•Itraconazole 100-400 mg/day for 12 months or more is useful in the treatment of coccidioidomycosis.

•Ketoconazole 200-400 mg/day for 12 months or more has resulted in improvement in patients with lung, skin, bone, and joint lesions.

•Fluconazole 100-300 mg/day may be useful.

•Amphotericin B 0.5-0.7 mg/kg per day for about 12-14 weeks is recommended in severe disease, particularly in patients with meningitis.

Future Therapies

Voriconazole has been shown to have in-vitro activity against C. immitis.

References

Diaz M, Puente R, de Hoyos LA, Cruz S. Itraconazole in the treatment of coccidioidomycosis. Chest 1991;100:682–684.

Drutz DJ. Amphotericin B in the treatment of coccidioidomycosis. Drugs 1983;26:337–341.

Ghannoum MA, Kuhn DM. Voriconazole: Better changes for patients with invasive mycoses. Eur J Med Res 2002;7:242–256.

Graybill JR, Stevens DA, Galgiani JN, et al. Itraconazole treatment of coccidioidomycosis. Am J Med 1990;89:282–290.