RESUMEN
Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978-2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.
Asunto(s)
Coccidioidomicosis , Humanos , Femenino , Masculino , Animales , Brasil/epidemiología , Coccidioidomicosis/epidemiología , Armadillos , Genómica , GenotipoRESUMEN
The National Reference Laboratory in Clinical Mycology of Argentina conducted a retrospective review of human coccidioidomycosis cases diagnosed by the National Mycology Laboratory Network of Argentina between 2010 and 2022 to determine the burden of the disease in the country. A total of 100 human coccidioidomycosis cases were documented, with a higher prevalence in male patients (male-to-female ratio of 1.9:1), with a median age of 41 years. Comparing the number of cases between two 10-year periods (2000-2009 and 2010-2019), the increase was 36.51% (from 63 to 86 cases). Among the 100 recorded cases, 79 tested positive using the double immunodiffusion test. Spherules were observed in 19 cases through histopathology or direct microscopic examination and the fungus was isolated in 39 cases. Thirty-six isolates were identified as Coccidioides posadasii through partial sequencing of the Ag2/PRA gene. Catamarca province had the highest number of cases, comprising 64% of the total, with an incidence rate above 1.0-2.5/100,000 inhabitants until 2018. However, there has been a recent downward trend in the region from 2018 to 2022. It is concerning that more than half of diagnosed cases were chronic pulmonary or disseminated forms, indicating a lack of early disease detection. To rectify this issue, it is imperative to conduct targeted training programs for healthcare personnel and enhance public awareness within the endemic area. This will contribute to a better understanding of the true burden of coccidioidomycosis and enable the implementation of appropriate sanitary control measures.
Asunto(s)
Coccidioides , Coccidioidomicosis , Humanos , Coccidioidomicosis/epidemiología , Coccidioidomicosis/microbiología , Argentina/epidemiología , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Coccidioides/genética , Coccidioides/aislamiento & purificación , Anciano , Adulto Joven , Prevalencia , Incidencia , Adolescente , Niño , Anciano de 80 o más Años , PreescolarRESUMEN
ABSTRACT: Coccidiomycosis is an infectious primary pulmonary disease caused by two highly virulent fungi, Coccidioides immitis and C. Posadasii. Coccidioides spp. are endemic to the southwestern USA, Central America, and South America with infection predominating in the summer and fall seasons. The disease commonly presents with flu-like symptoms. Cutaneous manifestations are rare and are a sign of a more serious infection with poorer outcomes. In this case, a 60-year-old female presented to the dermatology clinic with a 3-month history of a mild, non-pruritic, erythematous rash located on her proximal arms and legs. Two punch biopsies were obtained, and she was found to have a non-endemic case of disseminated coccidiomycosis.
Asunto(s)
Coccidioidomicosis , Micosis , Humanos , Femenino , Persona de Mediana Edad , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/tratamiento farmacológico , Coccidioides , Piel , América del Sur/epidemiologíaRESUMEN
Coccidioidomycosis, caused by the dimorphic pathogens Coccidioides posadasii and C. immitis, is a fungal disease endemic to the southwestern United States, Mexico, and some regions of Central and South America. The mouse is the primary model for studying pathology and immunology of disease. Mice in general are extremely susceptible to Coccidioides spp., which creates challenges in studying the adaptive immune responses that are required for host control of coccidioidomycosis. Here, we describe how to infect mice to model asymptomatic infection with controlled, chronic granulomas and a slowly progressive but ultimately fatal infection that has kinetics more similar to the human disease.
Asunto(s)
Coccidioidomicosis , Humanos , Animales , Ratones , Coccidioides , América del Sur/epidemiología , MéxicoRESUMEN
In this retrospective study, the clinical and anatomopathological findings of fungal diseases in dogs and cats in Northeastern Brazil are described. During the study period, 6,827 histopathological examinations (4,090 necropsies and 2,737 biopsies) of companion animals were reviewed, and fungal infections were diagnosed in 54 cases. Of these, 32 cases were diagnosed in cats and 22 in dogs. Sporotrichosis was the most prevalent mycosis (19/54), followed by dermatophytosis (9/54), cryptococcosis (8/54), candidiasis (7/54), and phaeohyphomycosis (4/54). Other diseases had two cases each, including aspergillosis, mucormycosis, and histoplasmosis, whereas coccidioidomycosis occurred once. Mycoses were diagnosed through microscopic lesions associated with the histomorphological characteristics of the agent, as evidenced by routine and special histochemical stains. They were occasionally confirmed by immunohistochemistry and microbiological cultivation. This retrospective study showed that despite being uncommon, fungal diseases are important causes of death in dogs and cats in the region, with cats being the most affected species and sporotrichosis being the most prevalent mycosis. Clinical signs were correlated with the portal of entry of the infection associated with localized or disseminated superficial and deep skin lesions or affecting parenchymal organs, especially in systemic infections. Microscopic lesions were mainly characterized by pyogranulomatous inflammation associated with fungal structures. In dogs, mycoses occurred mainly owing to an immunological impairment secondary to canine distemper virus co-infection.
Neste estudo retrospectivo, são descritos os achados clínicos e anatomopatológicos das doenças fúngicas em cães e gatos no Nordeste do Brasil. Durante o período de estudo, foram revisados 6.827 exames histopatológicos (4.090 necropsias e 2.737 biópsias) de animais de companhia e diagnosticados 54 casos de infecções fúngicas. Destes, 32 casos foram diagnosticados em gatos e 22 em cães. A esporotricose foi a micose mais prevalente (19/54), seguida pela dermatofitose (9/54), criptococose (8/54), candidíase (7/54) e feo-hifomicose (4/54). Outras doenças tiveram dois casos cada, incluindo aspergilose, mucormicose e histoplasmose, enquanto a coccidioidomicose ocorreu uma vez. As micoses foram diagnosticadas por meio das lesões microscópicas associadas às características histomorfológicas do agente, evidenciadas pelas colorações de rotina e histoquímicas especiais, e ocasionalmente confirmadas pela imuno-histoquímica e cultivo microbiológico. Esse estudo retrospectivo demonstrou que apesar de incomuns, as doenças fúngicas são importantes causas de morte em cães e gatos da região, sendo os gatos a espécie mais afetada e a esporotricose, a micose mais prevalente. Os sinais clínicos estavam correlacionados com a porta de entrada da infecção, associados a lesões cutâneas localizadas ou disseminadas superficiais e profundas ou afetando órgãos parenquimatosos, especialmente em infecções sistêmicas. As lesões microscópicas eram caracterizadas principalmente por inflamação piogranulomatosa associada a estruturas fúngicas. Nos cães, as micoses ocorreram principalmente devido ao comprometimento imunológico secundária a coinfecção pelo vírus da cinomose canina.
Asunto(s)
Animales , Gatos , Perros , Enfermedades de los Gatos/microbiología , Enfermedades de los Perros/microbiología , Micosis/patología , Micosis/veterinaria , Micosis/epidemiología , Aspergilosis/veterinaria , Esporotricosis/veterinaria , Tiña/veterinaria , Brasil/epidemiología , Candidiasis/veterinaria , Gatos/microbiología , Coccidioidomicosis/veterinaria , Criptococosis/veterinaria , Perros/microbiología , Feohifomicosis/veterinaria , Histoplasmosis/veterinaria , Mucormicosis/veterinariaRESUMEN
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare nodular mass that has not commonly been reported in the literature in association with coccidioidomycosis (CM). Coccidioidomycosis has other known skin manifestations including erythema nodosum and interstitial granulomatous dermatitis. Pulmonary CM is the most common form of the disease and the most common cause of CM-associated rash. This is an important clinical consideration for patients with ALHE who reside in CM-endemic areas, which notably include the southwestern region of the United States, Mexico, and South America. We report the case of an ALHE lesion that resolved following treatment for CM.
Asunto(s)
Hiperplasia Angiolinfoide con Eosinofilia , Coccidioidomicosis , Hemangioma , Hiperplasia Angiolinfoide con Eosinofilia/complicaciones , Hiperplasia Angiolinfoide con Eosinofilia/diagnóstico , Hiperplasia Angiolinfoide con Eosinofilia/patología , Coccidioidomicosis/complicaciones , Coccidioidomicosis/diagnóstico , Hemangioma/complicaciones , Humanos , MéxicoRESUMEN
Coccidioidomycosis (CM) is an endemic fungal disease that is prevalent in the Southwestern United States, Mexico, and Central and South America. The majority of cases are asymptomatic. Symptomatic cases primarily present with pneumonic disease, varying in severity from mild to severe. In a minority, extrapulmonary disease is known to occur. These disseminated cases typically manifest as meningitis, osteomyelitis, synovitis, and integumentary. Coccidioidomycosis has been identified in nearly every part of the body, including the soft tissues and cartilaginous tissues of the oropharynx. Disseminated CM to the larynx specifically in the pediatric populations is rarely documented. This is a case of persistent stridor misdiagnosed as viral croup in a 9-month-old male with protracted disease. Herein, diagnosis and treatment of laryngeal mass found to be CM are defined with a salutatory outcome.
Asunto(s)
Coccidioidomicosis , Crup , Meningitis , Niño , Coccidioidomicosis/diagnóstico , Crup/diagnóstico , Humanos , Lactante , Masculino , MéxicoRESUMEN
Coccidioidomycosis is an infectious disease caused by Coccidioides immitis or C. posadasii fungus. Humans usually get infected by inhaling spores risen from the soil. Although in 60 percent of cases symptoms are absent, remaining patients can develop various manifestations of the disease, from flu-like symptoms to severe dissemination or meningitis. In endemic regions (California, Arizona, Mexico, Central, and South America), pulmonary coccidioidomycosis causes 25% of community-acquired cases of pneumonia. We present the first registered case of pulmonary coccidioidomycosis in Lithuania. Clinical presentation, pathogenesis, treatment options, and diagnostic alternatives are discussed.
Asunto(s)
Coccidioidomicosis , Coccidioides , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/epidemiología , Humanos , Lituania , MéxicoRESUMEN
Coccidioidomycosis is a common fungal disease that is endemic to arid and semi-arid regions of both American continents. Coccidioides immitis and Coccidioides posadasii are the etiological agents of the disease, also known as Valley Fever. For several decades, the C. posadasii strain Silveira has been used widely in vaccine studies, is the source strain for production of diagnostic antigens, and is a widely used experimental strain for functional studies. In 2009, the genome was sequenced using Sanger sequencing technology, and a draft assembly and annotation were made available. In this study, the genome of the Silveira strain was sequenced using single molecule real-time sequencing PacBio technology, assembled into chromosomal-level contigs, genotyped, and the genome was reannotated using sophisticated and curated in silico tools. This high-quality genome sequencing effort has improved our understanding of chromosomal structure, gene set annotation, and lays the groundwork for identification of structural variants (e.g. transversions, translocations, and copy number variants), assessment of gene gain and loss, and comparison of transposable elements in future phylogenetic and population genomics studies.
Asunto(s)
Coccidioides , Coccidioidomicosis , Secuencia de Bases , Coccidioides/genética , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/epidemiología , Coccidioidomicosis/genética , Humanos , FilogeniaRESUMEN
Abstract Acute respiratory distress syndrome (ARDS) is a respiratory process of acute onset, showing on X rays as bilateral pulmonary infiltrates and severe respiratory failure, Coccidiodomycosis is a unusual cause of acute respiratory distress syndrome, the incidence of coccidiomycosis in a solid organ trasplant recipientes ranges from 1.4% a 6.9%, inadecuancy of cellular inmunity is a well established risk factor for development of coccididomcosis, less than 1% of patients develop disseminaded infecction and carrying high mortality, the case that we are presenting add to the small list of reports documenting the ocasionally acute and agressive nature of the disseminated clinical form of coccidiodomycosis.
Resumen El síndrome de dificultad respiratoria aguda (SDRA) es un proceso respiratorio de inicio agudo, que se manifiesta en las radiografías como infiltrados pulmonares bilaterales, clinicamente como insuficiencia respiratoria grave, la coccidiodomicosis es una causa inusual de síndrome de dificultad respiratoria aguda, la incidencia de coccidiomicosis en receptores de trasplante de órgano sólido varía desde 1.4% a 6.9%, una inadecuada inmunidad celular es un factor de riesgo bien establecido para el desarrollo de coccidomicosis, menos del 1% de los pacientes desarrollan enfermedad diseminada y alta mortalidad, el caso que presentamos se suma a la pequeña lista de informes que documentan la naturaleza ocasionalmente aguda y agresiva de la forma clínica diseminada de coccidiodomicosis.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria del Recién Nacido , Trasplante de Órganos , Trasplante de Hígado , Insuficiencia Respiratoria , Coccidioidomicosis , Inmunidad CelularRESUMEN
Coccidioidomycosis is a systemic disease caused by the fungi Coccidioides immitis and C. posadasii. It is a prevalent disease in arid regions with high temperatures and low precipitations in America. Coccidioidomycosis is a highly endemic disease of US-Mexico border states but commonly underdiagnosed. The diagnosis of coccidiomycosis is not easy due to the lack of specific symptoms; it is usually an integral approach, including clinical laboratory tests as an essential part of the diagnosis. Nevertheless, despite various laboratory tests available, affordability can be a limitation, mainly in developing countries. This review's objectives are 1) to learn the different laboratory approaches that arose and their application for clinical diagnosis; 2) to discuss their advantages and weaknesses, and finally, 3) propose what is on the horizon for future advances in clinical laboratory diagnosis of coccidioidomycosis. It has been a long way in laboratory tests evolution to detect coccidioidomycosis from tissue microscopy to Real-Time PCR. However, there is a delay in technology adoption for Coccidioides spp. detection in the clinical laboratory. The molecular Point of Care Testing (POCT) technology has reached us in our trench while research in PCR variants stills on-going. None of the currently existing scientific literature in coccidioidomycosis research has mentioned it. However, this trend in infectious and non-infectious disease diagnosis will continue in that way in order to offer better options for an easy and fast diagnosis. Undoubtedly, the implementation of molecular POCT for Coccidioides spp. would save resources in health care attention and improve access to diagnostic tools.
Asunto(s)
Coccidioidomicosis , Coccidioides/genética , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/epidemiología , Enfermedades Endémicas , Humanos , Laboratorios Clínicos , Reacción en Cadena de la PolimerasaRESUMEN
Coccidioidomycosis is a systemic fungal disease caused by Coccidioides immitis and Coccidioides posadasii. The lungs are the most common and often the initial site of involvement, and the non-pulmonary presentation is infrequent. We describe an unusual case of primary craniocutaneous coccidioidomycosis in a pregnant woman with infected bilateral periorbital nodules, intense pain at paranasal sinuses, and several osteolytic skull lesions. The analysis of 54 cases available in the literature makes us suggest that the area between the United States and Mexico is a risk zone for primary cutaneous coccidioidomycosis.
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Antifúngicos/uso terapéutico , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/fisiopatología , Anomalías Craneofaciales/diagnóstico , Anomalías Craneofaciales/microbiología , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/microbiología , Adulto , Coccidioides/aislamiento & purificación , Femenino , Humanos , México , Embarazo , Mujeres Embarazadas , Resultado del Tratamiento , Adulto JovenRESUMEN
We described a case of systemic infection by Coccidioides sp. in a dog. An adult, mixed breed, free-ranging male dog presented with clinical signs that included apathy, cachexia, anorexia, limited mobility with sternal recumbency, bilateral mucopurulent ocular discharge, dyspnoea, pulmonary crepitation, erosive and nodular lesions on the skin, and swelling and stiffness of the left tibiotarsal joint. The dog was submitted to a postmortem examination. Grossly, there were multiple yellow to white nodules in various organs. Histologically, the lesions were characterized as pyogranulomatous inflammation associated with fungal spherules morphologically consistent with Coccidioides sp. The dog was concomitantly diagnosed with undifferentiated sarcoma affecting the skin, lymph nodes, liver, and testicles. The diagnosis of coccidioidomycosis was made based on the histologic changes associated with morphotintorial features and positive immunolabeling of organisms with anti-Coccidioides immunohistochemistry. This case demonstrated that Coccidioides sp. can infect dogs that inhabit urban centers in the semiarid region of Northeastern Brazil, likely due to exposure to dust from contaminated environments.(AU)
Descreve-se um caso de infecção sistêmica por Coccidioides em um cão. Um cão adulto, sem raça definida e errante, atendido com sinais clínicos que incluíram apatia, caquexia, anorexia, dificuldade de locomoção com decúbito esternal, secreção ocular bilateral mucopurulenta, dispneia, crepitação pulmonar, lesões erosivas e nodulares na pele, aumento de volume e rigidez na articulação tibiotársica do membro pélvico esquerdo. O cão foi submetido a um exame post-mortem. Macroscopicamente, haviam múltiplos nódulos amarelo-brancacentos em vários órgãos. Histologicamente, as lesões foram caracterizadas por inflamação piogranulomatosa associada a esférulas fúngicas morfologicamente consistentes com Coccidioides sp. O cão foi diagnosticado concomitantemente com sarcoma indiferenciado afetando a pele, linfonodos, fígado e testículos. O diagnóstico de coccidioidomicose foi realizado com base nas alterações histológicas associadas as características morfotintoriais e imunomarcação positiva dos organismos com anti-Coccidioides na imuno-histoquímica. Esse caso demonstra que Coccidioides sp. pode infectar cães que habitam centros urbanos no semiárido do Nordeste do Brasil, provavelmente devido à exposição a poeira de ambientes contaminados.(AU)
Asunto(s)
Animales , Masculino , Perros , Enfermedades de los Perros/patología , Coccidioides/patogenicidad , Coccidioidomicosis/sangre , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/veterinariaRESUMEN
We described a case of systemic infection by Coccidioides sp. in a dog. An adult, mixed breed, free-ranging male dog presented with clinical signs that included apathy, cachexia, anorexia, limited mobility with sternal recumbency, bilateral mucopurulent ocular discharge, dyspnoea, pulmonary crepitation, erosive and nodular lesions on the skin, and swelling and stiffness of the left tibiotarsal joint. The dog was submitted to a postmortem examination. Grossly, there were multiple yellow to white nodules in various organs. Histologically, the lesions were characterized as pyogranulomatous inflammation associated with fungal spherules morphologically consistent with Coccidioides sp. The dog was concomitantly diagnosed with undifferentiated sarcoma affecting the skin, lymph nodes, liver, and testicles. The diagnosis of coccidioidomycosis was made based on the histologic changes associated with morphotintorial features and positive immunolabeling of organisms with anti-Coccidioides immunohistochemistry. This case demonstrated that Coccidioides sp. can infect dogs that inhabit urban centers in the semiarid region of Northeastern Brazil, likely due to exposure to dust from contaminated environments.
Descreve-se um caso de infecção sistêmica por Coccidioides em um cão. Um cão adulto, sem raça definida e errante, atendido com sinais clínicos que incluíram apatia, caquexia, anorexia, dificuldade de locomoção com decúbito esternal, secreção ocular bilateral mucopurulenta, dispneia, crepitação pulmonar, lesões erosivas e nodulares na pele, aumento de volume e rigidez na articulação tibiotársica do membro pélvico esquerdo. O cão foi submetido a um exame post-mortem. Macroscopicamente, haviam múltiplos nódulos amarelo-brancacentos em vários órgãos. Histologicamente, as lesões foram caracterizadas por inflamação piogranulomatosa associada a esférulas fúngicas morfologicamente consistentes com Coccidioides sp. O cão foi diagnosticado concomitantemente com sarcoma indiferenciado afetando a pele, linfonodos, fígado e testículos. O diagnóstico de coccidioidomicose foi realizado com base nas alterações histológicas associadas as características morfotintoriais e imunomarcação positiva dos organismos com anti-Coccidioides na imuno-histoquímica. Esse caso demonstra que Coccidioides sp. pode infectar cães que habitam centros urbanos no semiárido do Nordeste do Brasil, provavelmente devido à exposição a poeira de ambientes contaminados.
Asunto(s)
Masculino , Animales , Perros , Coccidioides/patogenicidad , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/sangre , Coccidioidomicosis/veterinaria , Enfermedades de los Perros/patologíaRESUMEN
INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS: This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS: Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS: Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.
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Coccidioidomicosis , Adulto , Brasil/epidemiología , Coccidioides , Coccidioidomicosis/diagnóstico por imagen , Coccidioidomicosis/tratamiento farmacológico , Fluconazol , Humanos , ItraconazolRESUMEN
To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.
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Coccidioidomicosis , Exposición Profesional , Adulto , California/epidemiología , Estudios de Casos y Controles , Coccidioides , Coccidioidomicosis/epidemiología , Agricultores , Femenino , Hispánicos o Latinos , Humanos , Masculino , MéxicoRESUMEN
Coccidioidomycosis is an endemic mycosis of the southern United States, Northern Mexico, and South America. Primary cutaneous coccidioidomycosis, despite being a very rare clinical presentation, has shown an increasing incidence. An extensive literature search for cutaneous coccidioidomycosis cases was performed using the OLDMEDLINE, PubMed, Cochrane, LILACS and Google Scholar databases for studies published from January 1927 through December 21, 2019. Forty-two observational studies were included totaling 82 cases of primary cutaneous coccidioidomycosis. Narrative reviews, systematic reviews, and meta-analyses were also included. Additionally, an original case was included. Patients with primary cutaneous coccidioidomycosis share the same geographical and epidemiological characteristics as those with pulmonary or disseminated coccidioidomycosis. Most of the imported cases came from endemic areas. A large portion of cases had prior local skin trauma. Tissue culture is still the leading diagnostic method; nevertheless, molecular techniques such as polymerase chain reaction (PCR) are currently relevant to differentiate between species. First-line treatment consists of azoles; however, it has an excellent prognosis even without treatment. Primary cutaneous coccidioidomycosis should be considered a differential diagnosis of unusual infections or neoformations in any part of the body in resident populations of endemic areas or in patients with a previous history of travel to these areas.
Asunto(s)
Antifúngicos/uso terapéutico , Coccidioides/aislamiento & purificación , Coccidioidomicosis/epidemiología , Dermatomicosis/epidemiología , Enfermedad Relacionada con los Viajes , Coccidioides/genética , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/microbiología , ADN de Hongos/aislamiento & purificación , Dermatomicosis/diagnóstico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/microbiología , Diagnóstico Diferencial , Enfermedades Endémicas/prevención & control , Enfermedades Endémicas/estadística & datos numéricos , Fluconazol/uso terapéutico , Humanos , Incidencia , Itraconazol/uso terapéutico , México/epidemiología , Micología/métodos , Estudios Observacionales como Asunto , Reacción en Cadena de la Polimerasa , Piel/microbiología , América del Sur/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Coccidioidal meningitis is a life-threatening condition and a diagnostic challenge in cases of chronic meningitis. It is associated to severe complications, like basal arachnoiditis, hydrocephalus, and secondary vasculitis. OBJECTIVE: To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center. RESULTS: The clinical records of 11 patients, predominantly males, were retrieved. Weight loss and night sweats were observed in 64 % of cases. Neurological signs included intracranial hypertension in 91 % of cases, altered alertness and meningeal syndrome in 72 %, and neuropsychiatric symptoms in 64 %. Mean CSF glucose levels were 30 ± 25 mg/dL, and pleocytosis ranged from 0 to 2218 cells/mm3. The diagnosis was confirmed by coccidioidal antigen latex agglutination in 91 % of cases. Radiological findings were hepatomegaly in 55 % of cases and pneumonia in 45 %. Neuroimaging findings included leptomeningitis in 73 % of cases, pachymeningitis in 45 %, and vascular involvement in 91 %. Less common findings included spinal cord lesion and mycotic aneurism, found in 18 % of cases. A molecular coccidioidal DNA test confirmed the predominance of Coccidioides immitis, detected in 64 % of cases. With respect to the clinical outcome, 46 % of patients died. The survivors suffered from sequels like chronic headache, cognitive alterations, and depression. CONCLUSIONS: Coccidioidal meningitis is an entity with high mortality rates. More than one half of patients suffered disseminated disease. Although meningeal signs are not frequent in chronic meningitis, more than two-thirds of our patients showed mild nuchal rigidity. In addition, cerebral and cerebellar volume loss, associated with cognitive impairment and depression, was often observed in surviving patients during the clinical-radiological follow-up.