1/127. 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.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/127. 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.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
3/127. 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.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
4/127. Airway coccidioidomycosis--report of cases and review.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.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
5/127. 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.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
6/127. hypercalcemia associated with infection by cryptococcus neoformans and coccidioides immitis.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.- - - - - - - - - - ranking = 1.2857142857143keywords = infection (Clic here for more details about this article) |
7/127. female genital coccidioidomycosis (FGC), Addison's disease and sigmoid loop abscess due to coccidioides immites; case report and review of literature on FGC.We describe a woman with unusual complications of infection with coccidioides immitis--infection of the genital tract and adrenal insufficiency. The patient also had intestinal coccidioidomycosis (cocci) in conjunction with presumed pulmonary, and asymptomatic central nervous system cocci. To our knowledge, concurrent FGC, intestinal and adrenal cocci have not been reported previously. A medline review from 1966-1997 revealed only 1 case of adrenal insufficiency due to cocci. FGC is rare; we identified 12 reported cases since 1929. No combination of investigations or clinical features is sensitive enough to predict FGC. diagnosis is usually made after microscopy of surgical specimens. FGC presents either as tubo-ovarian disease or endometritis. Treatment generally involves surgical excision and antifungal agents. We hypothesize that an initial trial of antifungals may obviate the need for surgery.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
8/127. coccidioidomycosis as imported atypical pneumonia in sweden.coccidioidomycosis, an endemic fungal infection of the western hemisphere causes serious disease in immunocompromised individuals. In immunocompetent patients, a moderate flu-like disease may develop. We report here an imported Scandinavian case of a culture-proven coccidioidomycosis, initially presenting as an atypical pneumonia. Pleuritic symptoms, positive epidemiology and eosinophilia led to suspicion of the diagnosis, which was further supported by serology.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
9/127. coccidioidomycosis fungal infection in the hand mimicking a metacarpal enchondroma.coccidioidomycosis, an infection caused by the fungus coccidioides immitis, rarely affects the hand, but we report an unusual case which mimicked the radiological appearance of an enchondroma in the metacarpal. curettage and bone grafting in combination with long-term antifungal therapy are necessary for successful treatment of coccidioidomycosis of the hand.- - - - - - - - - - ranking = 0.71428571428571keywords = infection (Clic here for more details about this article) |
10/127. coccidioidomycosis in compromised hosts. Experience at Stanford University Hospital.To determine the frequency and clinical characteristics of infection with coccidioides immitis in immunosuppressed patients at Stanford University Hospital, clinical records of 14 years were examined. Thirteen cases met the diagnostic criteria. Half had Hodgkin's disease. In six the infection was disseminated; five of the six died early in the course of their infectious illness, frequently without diagnosis. Conclusions include: 1. The occurrence of coccidioidomycosis in immunosuppressed patients seen at institutions in or adjacent to the endemic area is not as rare as the literature suggests. 2. Dissemination is frequently explosive and the radiographic appearance of pulmonary involvement may appear late. Widespread pulmonary dissemination may occur within 24 hours after a negative x-ray. 3. Although the skin test loses its diagnostic value, the serology remains valid. Thus immunosuppressed patients with febrile illnesses (with or without radiographically evident pulmonary involvement) who have a history of travel to an endemic area should have serological examinations. 4. Lymphocytopenia correlates with risk of dissemination of coccidioidomycosis. 5. The administration of immunsuppressive chemotherapy correlates with such risk while radiotherapy and the malignant or non-malignant nature of the disease do not.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
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