Coccidioidomycosis Lymphadenopathy

Coccidioidomycosis Lymphadenopathy

Article
Brain & Nerve
Bone, Muscle, & Joint
+5
Contributed byKrish Tangella MD, MBAAug 14, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Coccidioidomycosis causing Enlarged Lymph Nodes
  • Coccidioidomycosis Lymphadenitis
  • Enlarged Lymph Nodes due to Coccidioidomycosis

What is Coccidioidomycosis Lymphadenopathy? (Definition/Background Information)

  • Coccidioidomycosis Lymphadenopathy is the inflammation and enlargement of lymph nodes (usually in the head and neck area) due to underlying Coccidioidomycosis
  • Coccidioidomycosis is an infectious disease caused by inhaling the spores of two related fungi, namely Coccidioides immitis and Coccidioides posadasii, which are found in certain parts of South, Central, and North America
  • Mild Coccidioidomycosis can affect the upper respiratory system, lungs, and lymph nodes. However, a severe infection of Coccidioidomycosis may spread to other parts of the body (disseminated infection), such as the bones, joints, skin, tissues, and brain meninges, and cause serious complications
  • The signs and symptoms of Coccidioidomycosis Lymphadenopathy include significantly enlarged lymph nodes that are painless. However, the underlying Coccidioidomycosis infection can cause fever and chills, cough, muscle stiffness and aches, altered mental status, and swelling of the joints. The complications can include meningitis, severe pneumonia, and draining sinus tracts on the skin
  • The underlying fungal infection causing Coccidioidomycosis Lymphadenopathy is treated with antifungal medications. The disseminated form of Coccidioidomycosis is a fatal disease, if left untreated, and in such cases, the prognosis is typically poor

Who gets Coccidioidomycosis Lymphadenopathy? (Age and Sex Distribution)

  • Coccidioidomycosis Lymphadenopathy occurs due to underlying Coccidioidomycosis, which can affect any individual; though, infants, children, and older adults are more easily infected
  • Males are more easily affected than females
  • Coccidioides immitis is confined to the San Joaquin Valley region of California, while Coccidioides posadasii is more widespread in its distribution, ranging from the arid and dry regions of South America, Mexico, to the American southwest. The infection is not found in other parts of the world
  • Individuals living in or traveling to these regions (lower sonoran life zone) may be affected, since the fungus is endemic to this region

What are the Risk Factors for Coccidioidomycosis Lymphadenopathy? (Predisposing Factors)

The main risk factor for Coccidioidomycosis Lymphadenopathy is the underlying Coccidioidomycosis infection, and the potential risk factors for this infection include:

  • Individuals living in the endemic regions; travelling to areas that include the South Western New Mexico, Arizona, California, San Joaquin Valley, and Western Texas
  • Individuals with weak immune systems, which may be caused by:
    • AIDS/HIV infection
    • Cancer therapy, major surgeries
    • Diabetes
    • Taking medicines that suppresses or weakens the immune system (individuals taking immunosuppressive therapy after organ transplant)
  • Using medications that weaken the immune system such as:
    • Steroids
    • TNF-inhibitors
    • Chemotherapy drugs
    • Pregnancy
    • Cancers such as lymphoma

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Coccidioidomycosis Lymphadenopathy? (Etiology)

  • Coccidioidomycosis Lymphadenopathy is caused by Coccidioidomycosis infection that develops due to inhalation of the coccidioides spores present in air (carried by dust)
  • This infection may be caused by any of the two coccidioides species of fungus that include C. immitis and C. posadasii
  • The infection may be mild (acute form) or severe (disseminated form) depending on whether the infection is confined to the respiratory system or spreads to other body regions such as the bone and joints, skin, brain, etc.

What are the Signs and Symptoms of Coccidioidomycosis Lymphadenopathy?

The signs and symptoms of Coccidioidomycosis Lymphadenopathy may include:

  • Lymphadenopathy or enlarged lymph nodes that may be significant in size
  • Commonly, the lymph nodes of the head and neck region and mediastinum (chest) are involved
  • However, the condition may involve lymph nodes all over the body
  • The swollen lymph nodes are generally painless

Most often, individuals do not exhibit any signs and symptoms; but when it is present, it may be either mild or severe. Also, the associated signs and symptoms of underlying Coccidioidomycosis depend upon the health condition of the individual affected and the severity of the infection. The major signs and symptoms exhibited by disseminated Coccidioidomycosis may include:

  • Fever and chills
  • Cough
  • Headache
  • Stiffness of the muscle in the neck and shoulder, muscle aches
  • Altered mental status
  • Increased sensitivity to light
  • Arthritis: Swelling of the joints, joint pain; swelling is generally found in the ankle, feet and legs
  • Erythema nodosum - rashes and painful lumps on the lower legs
  • Occurrence  of skin nodules, ulcers, and other skin lesions
  • The painful lesions starts appearing in the skull, spine, or other bones
  • Meningitis: Inflammation that occurs in the protective  coverings surrounding the brain and spinal cord

How is Coccidioidomycosis Lymphadenopathy Diagnosed?

Coccidioidomycosis Lymphadenopathy is diagnosed using the following methods:

  • Complete evaluation of medical history along with a thorough physical examination (special focus on lung examination)
  • A neurological examination involving the brain and nervous system may show abnormalities
  • Diagnostic tests may include the following:
    • CBC with differential count
    • Chest x-ray (a chest radiograph): It is a painless, noninvasive procedure to take pictures of the structures, inside the chest
    • Coccidioides skin test: Also known as the spherulin test, this test helps to determine if an individual is infected with the fungus that causes coccidioidomycosis
    • Sputum KOH test: A laboratory test to check for the fungus in a sputum sample
    • Coccidioides complement fixation titer: A blood test that is conducted to detect antibodies to the fungus C. immitis
    • Sputum culture: This test is used for detecting and identifying fungus from a sputum culture. The test is generally used to diagnose a suspected respiratory tract infection
  • A tissue biopsy may be performed to determine the site of disseminated disease and it may include:
    • Bone marrow biopsy
    • Liver biopsy
    • Open lung biopsy
    • Skin lesion biopsy

Tissue biopsy: A sample of cells and tissues is examined by a pathologist under the microscope. Pathological examination is generally considered to be a ‘gold standard’ for a definitive diagnosis. The pathologist arrives at a diagnosis after analyzing the pathology findings along with clinical information of the patient. A pathologist may perform special studies on tissue samples to aid in the final diagnosis.

In majority of the cases, a lymph node biopsy is not performed for Coccidioidomycosis Lymphadenopathy. However, if the signs and symptoms persist despite suitable treatment, then a biopsy may be undertaken to rule-out other causes of swollen glands (such as a lymphoma).

In case of a lymph node biopsy, the following information may be noted:

  • Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
  • The lymph node biopsy may be performed through any of the following procedures:
    • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
    • Lymph node core biopsy of the enlarged lymph node
    • Lymph node open biopsy of the enlarged lymph node

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Coccidioidomycosis Lymphadenopathy?

Complications that may arise due to disseminated Coccidioidomycosis causing Lymphadenopathy may include:

  • Meningitis (inflammation of the protective membranes covering the brain and spinal cord)
  • Severe pneumonia
  • Draining sinus tracts on the skin

Various other complications may arise depending upon the spread of infection to the bones, lungs, liver, brain, skin, or heart and pericardium.

How is Coccidioidomycosis Lymphadenopathy Treated?

The following treatment methods are adopted to treat Coccidioidomycosis Lymphadenopathy and the underlying fungal infection:

  • Antifungal medications
  • Complete bed rest
  • Improved nutrition and overall health status

How can Coccidioidomycosis Lymphadenopathy be Prevented?

Currently, there are no definitive methods available to prevent Coccidioidomycosis Lymphadenopathy that results from Coccidioidomycosis infection; although, the following measures may be helpful:

  • Limit exposure to soil and dust if you are in coccidioides-endemic region
  • Avoid travelling to the regions where the fungus is endemic, especially if you have a poor immune system. Maintaining good health will help in reducing the severity of disseminated Coccidioidomycosis (if you contract the condition)
  • Being watchful of diseases and conditions that can suppress the immune system. This will help in preventing severe forms of the disease
  • If travelling to these regions is unavoidable, then efforts must be taken to avoid contact with the soil and dust in these regions, particularly if you have a weak immune system caused by HIV and other medical conditions
  • Medical attention should be sought immediately when the symptoms get worse and do not improve with  treatment, or when new symptoms begin to appear

What is the Prognosis of Coccidioidomycosis Lymphadenopathy? (Outcomes/Resolutions)

The prognosis of Coccidioidomycosis Lymphadenopathy is based on the severity of the underlying Coccidioidomycosis infection.

  • Without suitable treatment, disseminated Coccidioidomycosis is a fatal condition
  • Generally, the prognosis is not very good for those with disseminated forms of the infection. A high death rate has been observed with widespread Coccidioidomycosis
  • Death may be rapid in patients with weak immune system

Additional and Relevant Useful Information for Coccidioidomycosis Lymphadenopathy:

  • Coccidioides immitis and coccidioides posadasii are endemic in New Mexico, Texas, and parts of Central and South America, which are generally areas with mild winters and arid summers

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.

Was this article helpful

On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

0 Comments

Please log in to post a comment.

Related Articles

Test Your Knowledge

Asked by users

Related Centers

Loading

Related Specialties

Loading card

Related Physicians

Related Procedures

Related Resources

Join DoveHubs

and connect with fellow professionals

Related Directories

Who we are

At DoveMed, our utmost priority is your well-being. We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub - we genuinely care about your health journey. That's why we offer a variety of products tailored for both healthcare consumers and professionals, because we believe in empowering everyone involved in the care process.
Our mission is to create a user-friendly healthcare technology portal that helps you make better decisions about your overall health and well-being. We understand that navigating the complexities of healthcare can be overwhelming, so we strive to be a reliable and compassionate companion on your path to wellness.
As an impartial and trusted online resource, we connect healthcare seekers, physicians, and hospitals in a marketplace that promotes a higher quality, easy-to-use healthcare experience. You can trust that our content is unbiased and impartial, as it is trusted by physicians, researchers, and university professors around the globe. Importantly, we are not influenced or owned by any pharmaceutical, medical, or media companies. At DoveMed, we are a group of passionate individuals who deeply care about improving health and wellness for people everywhere. Your well-being is at the heart of everything we do.

© 2023 DoveMed. All rights reserved. It is not the intention of DoveMed to provide specific medical advice. DoveMed urges its users to consult a qualified healthcare professional for diagnosis and answers to their personal medical questions. Always call 911 (or your local emergency number) if you have a medical emergency!