This is a primary systemic mycosis caused by the dimorphic fungi Coccidioides immitis and C. posadasii, found in the south-western USA, and Central and South America.
SPREAD:- The disease is acquired by inhalation of conidia (arthrospores). In 60% of cases it is asymptomatic, but in the remainder it affects the lungs, lymph nodes and skin.
Rarely (in approximately 0.5%), it may spread haematogenously to bones, adrenal glands, meninges and other organs.
Pulmonary coccidioidomycosis has two forms: primary and progressive. If symptomatic, primary coccidioidomycosis presents with cough, fever, chest pain, dyspnoea and (commonly) arthritis and a rash (erythema multiforme). Progressive disease presents with systemic upset (e.g. fever, weight loss, anorexia) and features of lobar pneumonia, and may resemble tuberculosis.
Coccidioides meningitis (which may be associated with CSF eosinophils) is the most severe disease manifestation; it is fatal if untreated, and requires life-long suppressive therapy with antifungal azoles.
INVESTIGATIONS AND MANAGEMENT:-
Diagnosis is by direct detection (histopathological examination of infected tissue), culture of infected tissue or fluids, or antibody detection. IgM may be detected after 1–3 weeks of disease by precipitin TESTS. IGG APPEARS LATER AND IS DETECTED WITH THE COMPLEMENT FIXATION TEST. CHANGE IN IGG TITRE MAY BE USED TO MONITOR CLINICAL PROGRESS.
The medicines that can be thought of use are:-