Sketchy: Coccidioides immitis

Question 1

What are the clinical features of Cocci in healthy people?

Answer 1

• asymptomatic/subclinical
• acute PNA (fever, sweats, arthralgias)
• erythema nodosum

Question 2

What does the CXR look like in Coccidioides immitis?

Answer 2

either nothing or will have cavities and/or nodules

Question 3

Cue:

• Presidio San Juaqin

Answer 3

• Presidio = Coccidio; Southwestern USA
• Coccidioides immitis aka San Juaqin Valley Fever (all the dust)

Question 4

Cue:

• pale pillars of the wall with red spots all over the front of them

Answer 4

• pillars = legs
• red spots = erythema nodosum

Question 5

How is Coccidioides immitis diagnosed?

Answer 5

• KOH stain
• culture (takes a long time)
• serology (IgM against Cocci)

Question 6

Cue:

• pinecones and frogs

Answer 6

• tx for Coccidioides immitis:
• cones = -conazole for local
• amphibians = Amphotericin B for systemic

Question 7

How big are the Coccidioides immitis spherules compared to RBCs?

Answer 7

bigger than an RBC

Question 8

Cue:

• soldier sitting next to the statue wearing a neck brace and holding his head

Answer 8

• next to statue = disseminated infection
• holding head/neck brace = meningitis

Question 9

Cue:

• cracks in the ground

Answer 9

earthquakes spread the spores

Question 10

What are the clinical features of Cocci in immunocompromised people?

Answer 10

invades skin, lung, bone, and meninges (meningitis)

Question 11

How is Coccidioides immitis transmitted?

Answer 11

spores in dust are inhaled (dust storms, earthquakes)

Question 12

How is Coccidioides immitis treated?

Answer 12

• -conazole for local
• Amphotericin B for systemic

Question 13

Cue:

• large tumbleweeds (little circle patches in big spheres) and a small red sombrero blowing in the wind

Answer 13

• tumbleweeds = looks like smears: cocci form spherules filled with endospores inside the lungs
• red sombrero = RBC (smaller than spherules)

Question 14

Cue:

• butterfly

Answer 14

dimorphism (mold in the cold but SPHERULES OF ENDOSPORES in the heat)

Question 15

Cue:

• cracks and caved in bricks in the adobe wall

Answer 15

• cracks = shape of lungs
• bricks = nodules, cavities

Question 16

Cue:

• soldier falling on his knees as he coughs and sweats

Answer 16

• s/s of Coccidioides immitis PNA:
• sweats = fever
• coughing
• hitting knees = arthralgias

Question 17

Cue:

• cracked statue that has a cane

Answer 17

cracks = cavities in lung, bone (dissemination in immunocompromised pts- cane)