coccidiomycosis

Question 1

char

Answer 1

coccidioid grabuloma
valley fever
san joaquin valley fever

primary pulmo coccidiodomycosis :
Hilar adenopathu, perobronchial infiltrate, bronchopneumonia infiltrate.

onset- generalize maculopapular eruption. in a fee wks pulmo symptoms subside. - Skin manif appear in the form of erythema nodosum over shins thigs hips and buttocks.
EN- favorable prognostic sign.

disseminated dx is several fold higger in hispranics, native americans and many times higher ror african americans and filipinos. and vietnamese.

preg may predispose to systemic dx.

blood type B AB inc risk

donto derived organ transplant transmission has been documented in the 1st year.

Question 2

Disseminated coccidiomycosis ( coccidioidal granuloma)

Answer 2

Less of 1% pf infections.
target organs4 bones, joints; viscera; brain, meningesF skin.
skin lesions in 15-20% of patients.

face is freq involved

Question 3

primary cutanous coccidiomycosis

Answer 3

definite hx of inoculation.
bet 1 and 3 weeks after inoculation and indurated nodule dev that may ulcerate.

most pxs tx w systemic agents

Question 4

causative agent

Answer 4

c. immitis.

burrows of rodents at 20 cm or more depth.

Question 5

culture

Answer 5

culture at RT. and is highly infectious.

Question 6

immunooogy

Answer 6

primary cocc- low titer
disseminated- >1:32

if disseminated: CSF, synovial and peritoneal fluod can be tested for coccidioidal antibody.

+ igM - disseminated dx.

Question 7

tx

Answer 7

Fluconazole 400mg/ day
itraconazole sol 200 mg daily.
tx must be continued for 3-12 mos.

HIV- lifetime suppressive dose of 200 mg/day. and potent antiretroviral tx.

coccidiomycotic meningitis or severe disseminated dx- Comb of amphotericin b and fluconazole. posaconazole as second line agent.
Voriconazole in meningeal disease.

surgical debridement of abscess may be necesary.

primary inoculation- itraconazole 400 mg daily for 6 months.