Sketchy Micro: Coccidioidomycosis

Question 1

How can you associate this scene with Coccidioides?

Answer 1

It’s set at a Presidio (a Spanish military base), which rhymes with Coccidio.

Question 2

Where is Coccidioides distributed?

Answer 2

Coccidioides is found in the southwestern United States (hence the southwestern setting and the map with California, Arizona, New Mexico, and Texas shaded).

Question 3

Another name for Coccidioidomycosis is ____________.

Answer 3

San Joaquin Valley fever (hence, this base is called Presidio San Joaquin)

Question 4

How is Coccidioides transmitted?

Answer 4

Its spores get inhaled in dust, often during dust storms or earthquakes.

(Think of the dust rising from the crack in the ground.)

Question 5

How is the dimorphism of Coccidioides different?

Answer 5

It is a dimorphic fungi (think of the butterfly) and it is a mold in the cold, but in the body (the heat) it is a swelling spheroid that ruptures and sends out endospores (like the tumblesweeds).

Question 6

If you see an endospore on histologic exam, how can you know it is an endospore as opposed to a dividing Blastomycosis?

Answer 6

The endospores are larger than RBCs, whereas Blasto is roughly the size of RBCs.

(Think of the tumbleweed that is larger than the RBC-looking sombrero.)

Question 7

What can Coccidioides cause in a healthy person?

Answer 7

• Fever (guy sweating near crack)
• Arthralgia (guy kneeling near crack)
• Pneumonia (guy coughing near crack) with cavities and nodules (on the wall)
• Erythema nodosum (bumpy shin-looking pillars behind guy coughing)

Question 8

What lung pathologies can Coccidioides cause?

Answer 8

Cavities and nodules (like the craters and pushed-out bricks on the wall behind the guy coughing)

Question 9

True or false: erythema nodosum is a sign of Coccidioidomycosis in immunocompromised individuals.

Answer 9

False. Erythema nodosum is a sign of a robust immune response, so it will only appear in health people.

Question 10

What presentation is typical of Coccidioidomycosis in an immunocompromised person?

Answer 10

• Skin infections (cracks in the statue’s skin)
• Lung cavities (cracks over the statue’s chest)
• Osteomyelitis (iron rod in the statue’s leg)
• Meningitis (soldier leaning on fountain with neck brace)

Question 11

What two treatments are indicated for Coccidioidomycosis?

Answer 11

Ketoconazole for the healthy (like the pine cones by the guy coughing) and amphotericin B for the immunocompromised (like the frogs in the fountain)