1/8. 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 = 1keywords = physician (Clic here for more details about this article) |
2/8. coccidioidomycosis in non-endemic areas: a case series.coccidioidomycosis is a systemic infection caused by the soil fungus coccidioides immitis, which is endemic to the south-western United States. Manifestations range from flu-like illness to pneumonia and septic shock. diagnosis may be delayed or missed in non-endemic areas because of the low index of suspicion. We describe a series of 23 patients with coccidioidomycosis at one institution in a non-endemic area. diagnosis was often delayed. In two patients, the route of exposure could not be determined, but 20 patients had a history of residence or travel to endemic areas, and the remaining patient had an occupational history of exposure to fomites from an endemic region. Five patients were immunosuppressed. Most patients responded well to medical therapy, surgery, or both. Although coccidioidomycosis is rare in non-endemic areas, physicians must keep it in mind when evaluating patients who have traveled to endemic areas or who are immunosuppressed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Disseminated coccidioidomycosis with intra- and paravertebral abscesses.We report a case of paravertebral and intravertebral abscesses caused by coccidioides immitis in a Japanese man. The patient had lived in arizona, United States, for 5 years, and suffered from overt disease after coming back to japan. culture of pus from the paravertebral abscess revealed coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made. fluconazole (600 mg/day), taken orally, was started, and the abscesses surrounding the vertebral bodies disappeared after 2 years of treatment. The abscess in the vertebral bodies also responded to treatment, but a small lesion was still left in the 10th vertebral body after 2 years of treatment. coccidioidomycosis is a fungal infection that is endemic in the southwestern united states and in Central and south america. Although coccidioidomycosis causes self-limiting flu-like illness or pneumonia, a small proportion of the infections progress to disseminated diseases. Because the incidence of coccidioidomycosis is increasing year by year, physicians not only in endemic but also in nonendemic areas have to consider coccidioidomycosis as one of the differential diagnoses when they examine patients from endemic areas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. The unique complications of coccidioidomycosis of the spine: a detailed time line of disease progression and suppression.STUDY DESIGN: A case report is presented. OBJECTIVE: We report a detailed time-line of disease progression and suppression in a patient with disseminated coccidioidomycosis of the spine. The importance of consistent and thorough treatment to prevent disease recurrence is underscored. SUMMARY OF BACKGROUND DATA: coccidioides immitis is a dimorphic fungus that lives as a saprophyte in arid, alkaline soils and as a parasite in the tissues of its host. Endemic to the arid soil of the American Southwest and Central and south america, its disease prevalence is increasing. There are 100,000 new infections diagnosed each year, of which 34% are symptomatic. Of the symptomatic individuals 5-10% will develop a serious pulmonary infection and of those that have a serious infection less than 1% will develop chronic pulmonary disease and/or extrapulmonary dissemination. methods: A 36-year-old black woman with a 3-year history of recent migration to the desert Southwest and a family history of sarcoidosis presented to her primary care physician with shortness of breath and a cough of 2 months' duration. An anterior-posterior radiograph revealed bilateral hilar lymphadenopathy and sarcoidosis was diagnosed. The patient was placed on oral prednisone and progressively worsened. She was referred to the Orthopedic Clinic with a complaint of severe back pain. RESULTS: Plain radiographs of the lumbar spine revealed lytic erosion of the sacral promontory. Computed tomography confirmed the sacral lesion in addition to revealing involvement of the fifth lumbar vertebral body. Over the ensuing years the patient underwent a course of operative and chemotherapeutic therapies. She endured numerous complications of the disease, one of which is being reported for the first time. Control of her disease has been accomplished through radical surgical debridement, spinal stabilization with concomitant local and systemic chemotherapy. CONCLUSIONS: The prevalence and distribution of coccidioidomycosis is increasing as is the likelihood of seeing its often unique and bizarre clinical manifestations and complications. If included in the differential diagnosis, the disease can be recognized earlier and the likelihood of numerous complications can be avoided. Once bony involvement is diagnosed a regimen of aggressive surgical debridement as well as consistent chemotherapy must be employed if remission and/or eradication of the illness are sought.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. coccidioidomycosis diagnosed in south carolina.Primary care physicians in the Eastern United States rarely consider coccidioidomycosis in the differential diagnosis of pulmonary infections or febrile illnesses. However, the mobility of the population mandates consideration of this diagnosis, particularly in patients with fever and cough that do not resolve rapidly and in patients with adenopathy on chest radiography. In this report, we describe two unrelated cases encountered during a single week in a south carolina internal medicine practice. These cases highlight the importance of obtaining travel histories from patients with atypical pulmonary infections. Early consideration of coccidioidomycosis confers several benefits, including allaying patient anxiety by more timely diagnosis, minimizing the empiric use of antibiotics, and reducing the need for extensive and possibly invasive diagnostic testing.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Isolated nodular cutaneous coccidioidomycosis. The initial manifestation of disseminated disease.Cutaneous manifestations of coccidioidomycosis may be divided into primary and secondary lesions. Since such lesions may be the only evidence of infection, the distinction is important. Primary (inoculation) lesions are rare. Secondary lesions develop from primary pulmonary disease, commonly. An isolated nodule on the scalp was the presenting sign of disseminated coccidioidomycosis in our patient. Because of the rarity of primary cutaneous coccidioidomycosis, cutaneous lesions due to it should alert the physician to the presence of disseminated disease. The clinical spectrum of such lesions is wide. Our patient was an elderly man with a hyperkeratotic scalp nodule clinically felt to be an actinic keratosis or an early squamous cell carcinoma. We suggest that patients with a travel or resident history in endemic areas be viewed with a high index of suspicion for skin lesions of cutaneous coccidioidomycosis. The advent of orally administered imidazole antifungal agents makes early and aggressive diagnosis of these lesions even more important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. coccidioidomycosis in california: regional outbreak, global diagnostic challenge.Beginning in 1991, case reports of coccidioidomycosis in california increased dramatically, pursuant to a variety of natural and demographic factors. This highly infectious fungal disease with propensity to disseminate widely, mimic other conditions, and cause pathology at locations distant in place and time is readily treatable if recognized at an early stage. The concentration of military bases in endemic areas and the mobility of military personnel suggest a heightened potential for case presentations elsewhere and a need for elevated diagnostic suspicion on the part of military physicians worldwide. We review three cases of disseminated disease recently referred to our facility.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. coccidioidomycosis--United States, 1991-1992.During 1991, reported cases of coccidioidomycosis (i.e., valley fever) in california increased more than three-fold over the annual number of cases reported since 1986; during 1992, the number of reported cases increased 10-fold. coccidioidomycosis, a fungal disease caused by coccidioides immitis, is endemic in certain parts of arizona, california, nevada, new mexico, texas, and utah. Sporadic cases occur each year in parts of the United States in which the disease is not endemic and may present diagnostic difficulties and laboratory hazards because health-care workers may be unfamiliar with coccidioidomycosis. Recent increases in california and reports of isolated cases in areas without endemic disease suggest that physicians and laboratory personnel should be alert to the possible role of C. immitis. This report summarizes the occurrence of coccidioidomycosis in california during 1991 and 1992 and highlights three cases that occurred in areas in which the disease is not endemic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |