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Acute Pulmonary Coccidioidomycosis

occidioidomycosis is an infectious disease caused by inhaling the spores of two related fungi, namely Coccidioides immitis and Coccidioides posadasii.

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

  • Acute Coccidioides Immitis Infection
  • San Joaquin Valley Fever caused by Acute Pulmonary Coccidioidomycosis
  • Valley Fever caused by Acute Pulmonary Coccidioidomycosis

What is Acute Pulmonary Coccidioidomycosis? (Definition/Background Information)

  • Coccidioidomycosis is an infectious disease caused by inhaling the spores of two related fungi, namely Coccidioides immitis and Coccidioides posadasii
  • C. posadasii is found in the soil of dry and low rainfall areas  and desert regions in certain parts of the South Western U.S, Mexico, Central and South America; C. immitis is found in California
  • A mild attack of coccidioidomycosis affects the upper respiratory system, lungs, and lymph nodes. A serious attack of coccidioidomycosis may spread to other parts of the body, such as the bones, joints, skin, tissues, and brain meninges, and may cause some serious complications

The types of coccidioidomycosis include:

  • Acute Coccidioidomycosis
  • Chronic Coccidioidomycosis
  • Disseminated Coccidioidomycosis

Acute Pulmonary Coccidioidomycosis is a mild form of the infection, which lasts for a very short time period.

  • The signs and symptoms of Acute Pulmonary Coccidioidomycosis begin to appear within 1-3 weeks after inhaling the fungus. In majority of cases, the signs and symptoms are similar to a flu-like illness
  • Complications of the infection include progression of the condition to its chronic infection form and spread of the fungus throughout the body. This causes disseminated coccidioidomycosis that can be fatal without proper treatment
  • 95% of those infected recover completely without any treatment. The prognosis of Acute Pulmonary Coccidioidomycosis is excellent, since it is a self-limiting infection

Who gets Acute Pulmonary Coccidioidomycosis? (Age and Sex Distribution)

  • Acute Pulmonary Coccidioidomycosis can affect individuals of any age group
  • Typically, it affects males more frequently 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 any 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 Acute Pulmonary Coccidioidomycosis? (Predisposing Factors)

The risk factors for Acute Pulmonary Coccidioidomycosis 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)          
  • Male gender
  • Pregnant women
  • People involved in construction work, farm work, or any work that disturbs the soil or involves dust
  • Outdoor activities, such as camping, biking
  • Elderly adults
  • Smokers
  • Military personnel in the region
  • Archeologists
  • Natives of American, African, or Philippine descent are at increased risk for the disseminated form of coccidioidomycosis

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 Acute Pulmonary Coccidioidomycosis? (Etiology)

  • Acute Pulmonary Coccidioidomycosis is an airborne-infection that is acquired by 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 or severe 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 Acute Pulmonary Coccidioidomycosis?

Acute Pulmonary Coccidioidomycosis is a very mild form of the infection; most of the time the affected individuals do not exhibit any symptoms (in about 60% of the cases). The signs and symptoms usually appear within 5-21 days of exposure to the fungus and may include:

  • Mild to severe chest pain
  • Cough that may contain blood
  • Fever and chills
  • Night sweats
  • Headache
  • Pain and stiffness of the joints, muscle aches, stiffness of the muscles
  • Swelling of the lymph nodes
  • Erythema nodosum - rashes and painful lumps that occurs on the lower legs
  • Redness of the eyes

How is Acute Pulmonary Coccidioidomycosis Diagnosed?

The diagnosis of Acute Pulmonary Coccidioidomycosis may include:

  • Complete evaluation of medical history along with a thorough physical examination (special focus on lung examination)
  • Blood test to check for antibodies to the fungus
  • Chest x-ray or CT scan
  • Complete blood count (CBC)
  • Biopsy of lung or the lymph node
  • Bronchoscopy: It is a procedure that enables the physician to look inside the lungs and airways, using an instrument called the bronchoscope

Lung biopsy: A sample of lung (cells and tissues) is examined by a pathologist under a 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.

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 Acute Pulmonary Coccidioidomycosis?

Acute Pulmonary Coccidioidomycosis rarely poses any complications and in most cases, it does not require any treatment too. However, a few complications that may arise include:

  • Chronic Pulmonary Coccidioidomycosis: A severe form of the disease that shows up months or years after being infected by the fungus
  • Disseminated Coccidioidomycosis: In very rare cases, the fungus may spread from the lungs through the bloodstream and affect various parts of the human body such as the skin, bones, joints, lymph nodes, and even the central nervous system

How is Acute Pulmonary Coccidioidomycosis Treated?

Acute Pulmonary Coccidioidomycosis generally does not need any treatment; it resolves on its own. However, the healthcare provider may recommend the following measures:

  • Complete bed rest
  • Symptomatic treatment, such as tylenol for fever

How can Acute Pulmonary Coccidioidomycosis be Prevented?

Currently, there are no definitive methods available to prevent Acute Pulmonary Coccidioidomycosis; though, 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
  • 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

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

  • Acute Pulmonary Coccidioidomycosis is a very mild fungal infection caused by the coccidioides species. Frequently, it resolves on its own, without presenting any complications
  • The overall prognosis is generally very good, since it is a self-limiting infection in 95% of the cases

Additional and Relevant Useful Information for Acute Pulmonary Coccidioidomycosis:

  • Acute Pulmonary Coccidioidomycosis is also known as San Joaquin Valley Fever, after the region where this fungus is commonly found
  • The California Department of Public Health has estimated that about 150,000 people in the United States are affected by Valley Fever every year

What are some Useful Resources for Additional Information?

Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
Email: cdcinfo@cdc.gov
Website: http://www.cdc.gov

Valley Fever Center for Excellence
1656 E. Mabel St., P.O. Box 245215, Tucson, Arizona 85724-4224
Phone: (520) 626-6517
Fax: (520) 626-4971
Email: vfever@email.arizona.edu
Website: http://vfce.arizona.edu

References and Information Sources used for the Article:

http://www.drexelmed.edu/Home/HealthEncyclopediaArticles/DiseasesandConditions/Coccidioidomycosisacutepulmonary.html (accessed on 5/3/2015)

http://www.pennmedicine.org/encyclopedia/em_displayArticle.aspx?gcid=000094 (accessed on 5/3/2015)

http://www.oocities.org/medipedia/000094.htm (accessed on 5/3/2015)

http://cid.oxfordjournals.org/content/41/9/1217.full (accessed on 5/3/2015)

http://www.nlm.nih.gov/medlineplus/ency/article/001322.htm (accessed on 5/3/2015)

Helpful Peer-Reviewed Medical Articles:

Chiller  TMGalgiani  JNStevens  DA Coccidioidomycosis. Infect Dis Clin North Am2003;1741- 57

Galgiani  JN Coccidioidomycosis. West J Med 1993;159153- 171

Galgiani JN. Coccidioidomycosis: a regional disease of national importance. Rethinking approaches for control. Ann Intern Med. 1999;130(4 Pt 1):293–300.

Ampel NM, Dols CL, Galgiani JN. Coccidioidomycosis during human immunodeficiency virus infection: results of a prospective study in a coccidioidal endemic area. Am J Med. 1993;94(3):235–240.

Parish, J. M., & Blair, J. E. (2008). Coccidioidomycosis. Mayo Clin Proc, 83(3), 343-348; quiz 348-349. doi: 10.4065/83.3.343

Spinello, I. M., Munoz, A., & Johnson, R. H. (2008). Pulmonary coccidioidomycosis. Semin Respir Crit Care Med, 29(2), 166-173. doi: 10.1055/s-2008-1063855

Thompson, G. R., 3rd. (2011). Pulmonary coccidioidomycosis. Semin Respir Crit Care Med, 32(6), 754-763. doi: 10.1055/s-0031-1295723

Welsh, O., Vera-Cabrera, L., Rendon, A., Gonzalez, G., & Bonifaz, A. (2012). Coccidioidomycosis. Clin Dermatol, 30(6), 573-591. doi: 10.1016/j.clindermatol.2012.01.003