Pulmonary Coccidioidomycosis

ABSTRACT

Coccidioidal infection can manifest as pulmonary or extrapulmonary disease. Pulmonary coccidioidomycosis occurs in 95% of all cases and can be divided into three main categories: primary, complicated, and residual pulmonary coccidioidomycosis.

The primary infection occurs with inhalation of airborne arthroconidia. As few as 10 arthroconidia are capable of causing an infection in animal models. Sixty percent of infected individuals will remain asymptomatic. This results in a positive skin test and, with rare exception, lifelong immunity. The other 40% will develop symptomatic disease that manifests with variable signs and symptoms, predominantly an influenza-like syndrome, pneumonia, or pleural effusion.

The category of complicated pulmonary coccidioidomycosis includes clinical entities as severe and persistent pneumonia, progressive primary coccidioidomycosis, fibrocavitary coccidioidomycosis, cavities, and empyema, a complication of a ruptured cavity. Progression of primary pulmonary disease to acute respiratory distress syndrome (ARDS) can also qualify as a complication.

The third category of residual disease comprises only two entities: pulmonary nodule and fibrosis. This review focuses on uncomplicated and complicated pulmonary coccidioidomycosis and its management as outlined earlier in addition to special considerations of coccidioidal fungemia, pulmonary coccidioidomycosis in pregnancy, and organ transplantation.

KEYWORDS

Pulmonary coccidioidomycosis - complicated pulmonary coccidioidomycosis - residual pulmonary coccidioidomycosis - progressive primary coccidioidomycosis - fibrocavitary coccidioidomycosis

REFERENCES

• 1 Posadas A. Ensayo anatomopatologico sobre una neoplasia considerada como micosis fungoidea.  An Circ Méd Argent. 1892;  15-18
• 2 Rixford E, Gilchrist T C. Two cases of protozoan (coccidioidal) infection of the skin and other organs.  Johns Hopkins Hosp Rep. 1896;  209-268
• 3 Dickson E C. Coccidioidomycosis; the preliminary acute infection with fungus coccidioides.  JAMA. 1938;  111 1362-1364
• 4 Gifford M A, Buss W C, Douds R J. Data on Coccidioides fungus infection, Kern County, 1900-1936. In: Kern County Health Department, Annual Report 1936-1937: 39-54
• 5 Ophüls W. Further observations on a pathogenic mould formerly described as a protozoon (Coccidioides immitis, Coccidioides pyogenes).  J Exp Med. 1905;  6 443-486
• 6 Fischer M C, Koenig G L, White T J, Taylor J W. Molecular and phenotypic description of Coccidioides posadasii sp. nov., previously recognized as the non-California population of Coccidioides immitis .  Mycologia. 2002;  94 73-84
• 7 Stevens D A. Coccidioidomycosis.  N Engl J Med. 1995;  332 1077-1082
• 8 Johnson R H, Munoz A D, Ragland A S. Soil borne illnesses. In: Lessenger J Handbook of Agricultural Medicine. New York; Springer-Verlag 2005
• 9 Petersen L R, Marshall S L, Barton-Dickson C et al.. Coccidioidomycosis among workers at an archaeological site, northeastern Utah.  Emerg Infect Dis. 2004;  10 637-642
• 10 Ampel N M. Coccidioidomycosis in persons infected with HIV type 1.  Clin Infect Dis. 2005;  41 1174-1178
• 11 Wright P W, Pappagiannis D, Wilson M et al.. Donor-related coccidioidomycosis in organ transplant recipients.  Clin Infect Dis. 2003;  37 1265-1269
• 12 Blair J E, Smilack J D, Caples S M. Coccidioidomycosis in patients with hematologic malignancies.  Arch Intern Med. 2005;  165 113-117
• 13 Crum N F, Lederman E R, Stafford C M et al.. Coccidioidomycosis: a descriptive survey of a reemerging disease: clinical characteristics and emerging controversies.  Medicine (Baltimore). 2004;  83 149-175
• 14 Deresinski S C, Pappagianis D, Stevens D. Association of ABO blood group and outcome of coccidioidal infections.  Sabouraudia. 1979;  17 261-264
• 15 Rosenstein N E, Emery K W, Werner S B et al.. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern county, California, 1995-1996.  Clin Infect Dis. 2001;  32 708-714
• 16 Johnson R H, Caldwell J W, Welch G, Einstein H E. The great coccidioidomycosis epidemic: clinical features. In: Proceedings of the 5th International Conference Stanford University August 24-27, 1994: 77-87
• 17 Bayer A S. Fungal pneumonias; pulmonary coccidioidal syndromes, I: Primary and progressive primary coccidioidal pneumonias-diagnostic therapeutic, and prognostic considerations.  Chest. 1981;  79 575-583
• 18 Lonky S A, Catanzaro A, Moser K M, Einstein H. Acute coccidioidal pleural effusion.  Am Rev Respir Dis. 1976;  114 681-688
• 19 Bayer A S. Fungal pneumonias: pulmonary coccidioidal syndromes, II: Miliary, nodular, and cavitary pulmonary coccidioidomycosis; chemotherapeutic and surgical considerations.  Chest. 1981;  79 686-691
• 20 Anstead G M, Graybill J R. Coccidioidomycosis.  Infect Dis Clin North Am. 2006;  20 621-643
• 21 Galgiani J N. Coccidioidomycosis.  West J Med. 1993;  159 153-171
• 22 Winn R E, Johnson R, Galgiani J N, Butler C, Pluss J. Cavitary coccidioidomycosis with fungus ball formation: diagnosis by fiberoptic bronchoscopy with coexistence of hyphae and spherules.  Chest. 1994;  105 412-416
• 23 Galgiani J N, Ampel N M, Blair J E et al.. Coccidioidomycosis.  Clin Infect Dis. 2005;  41 1217-1223
• 24 Arsura E L, Kilgore W B. Miliary coccidioidomycosis in the immunocompetent.  Chest. 2000;  117 404-409
• 25 Spinello I M, Johnson R H. A 19-year-old pregnant woman with a skin lesion and respiratory failure.  Chest. 2006;  130 611-615
• 26 Shibli M, Ghassibi J, Hajal R, O'Sullivan M. Adjunctive corticosteroids therapy in acute respiratory syndrome owing to disseminated coccidioidomycosis.  Crit Care Med. 2002;  30 1896-1898
• 27 Sajit S, Spinello I M, Munoz A, Johnson R H. Respiratory failure in pulmonary coccidioidomycosis: is there a role for steroids?. Proceedings of the 48th annual coccidioidomycosis study group meeting April 3, 2004 Rosarito, Mexico;
• 28 Bozzette S A, Sattler F R, Chiu J et al.. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group.  N Engl J Med. 1990;  323 1451-1457
• 29 Rempe S, Sachdev M S, Bhakta R, Pineda-Roman M, Vaz A, Carlson R W. Coccidioides immitis fungemia: clinical features and survival in 33 adult patients.  Heart Lung. 2007;  36 64-71
• 30 Ahmed A J, Kruse J A, Haupt M T, Chandrasekar P H, Carlson R W. Hemodynamic responses to gram-positive versus gram-negative sepsis in critically ill patients with and without circulatory shock.  Crit Care Med. 1991;  19 1520-1525
• 31 Blair J E, Logan J L. Coccidioidomycosis in solid organ transplantation.  Clin Infect Dis. 2001;  33 1536-1544
• 32 Blair J E. Coccidioidal pneumonia, arthritis, and soft tissue infection after kidney transplantation.  Transpl Infect Dis. 2004;  6 74-76
• 33 Logan J L, Blair J E, Galgiani J N. Coccidioidomycosis complicating solid organ transplantation.  Semin Respir Infect. 2001;  16 251-256
• 34 Tripathy U, Yung G L, Kriett J M et al.. Donor transfer of pulmonary coccidioidomycosis in lung transplantation.  Ann Thorac Surg. 2002;  73 306-308
• 35 Blair J E, Douglas D D, Mulligan D C. Early results of targeted prophylaxis for coccidioidomycosis in patients undergoing orthotopic liver transplantation within an endemic area.  Transpl Infect Dis. 2003;  5 3-8
• 36 Miller M B, Hendren R, Gilligan P H. Posttransplantation disseminated coccidioidomycosis acquired from donor lungs.  J Clin Microbiol. 2004;  42 2347-2349
• 37 Hall K A, Sethi G K, Rosado L J et al.. Coccidioidomycosis and heart transplantation.  J Heart Lung Transplant. 1993;  12 525-526
• 38 Pappagianis D. Epidemiology of coccidioidomycosis. In: Stevens D Coccidioidomycosis. New York; Plenum 1980: 63-85
• 39 Crum N F, Ballon-Landa G. Coccidioidomycosis in pregnancy: case report and review of the literature.  Am J Med. 2006;  119 993.e11-17
• 40 Ostrosky-Zeichner L, Marr K A, Rex J H et al.. Amphotericin B: time for a new “gold standard”.  Clin Infect Dis. 2003;  37 415-425
• 41 Deresinski S C. Coccidioidomycosis: efficacy of new agents and future prospects.  Curr Opin Infect Dis. 2001;  14 693-696
• 42 Hostetler J S, Heykants J, Clemons K V et al.. Discrepancies in bioassay and chromatography determinations explained by metabolism of itraconazole to hydroxyitraconazole: studies of interpatient variations in concentrations.  Antimicrob Agents Chemother. 1993;  37 2224-2227
• 43 McCarthy K L, Playford G, Looke D FM, Whitby M. Severe photosensitivity causing multifocal squamous cell carcinomas secondary to prolonged voriconazole therapy.  Clin Infect Dis. 2007;  44 e55-e56
• 44 Walsh T J, Finberg R W, Arndt C et al.. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia.  N Engl J Med. 1999;  340 764-771
• 45 Graybill J R, Stevens D A, Galgiani J N, Dismukes W E, Cloud G A. Itraconazole treatment of coccidioidomycosis. NIAID Mycoses Study Group.  Am J Med. 1990;  89 282-290
• 46 Galgiani J N, Stevens D A, Graybill J R, Dismukes W E, Cloud G A. Ketoconazole therapy of progressive coccidioidomycosis: comparison of 400 and 800 mg doses and observations at higher doses.  Am J Med. 1988;  84 603-610
• 47 Catanzaro A, Galgiani J N, Levine B E et al.. Fluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis.  Am J Med. 1995;  98 249-256