Coccidioidal Pneumonia, Phoenix, Arizona, USA, 2000-2004

Mayo Clinic, Scottsdale, Arizona 85259, USA.
Emerging Infectious Diseases (Impact Factor: 7.33). 04/2009; 15(3):397-401. DOI: 10.3201/eid1563.081007
Source: PubMed

ABSTRACT Community-acquired pneumonia (CAP) often results in severe illness and death. In large, geographically defined areas where Coccidioides spp. are endemic, coccidioidomycosis is a recognized cause of CAP, but its frequency has not been studied extensively. To determine the frequency of patients with coccidioidomycosis, we conducted a prospective evaluation of 59 patients with CAP in the Phoenix, Arizona, area. Of 35 for whom paired coccidioidal serologic testing was performed, 6 (17%) had evidence of acute coccidioidomycosis. Coccidioidal pneumonia was more likely than noncoccidioidal CAP to produce rash. The following were not found to be risk factors or reliable predictors of infection: demographic features, underlying medical conditions, duration of time spent in disease-endemic areas, occupational and recreational activities, initial laboratory studies, and chest radiography findings. Coccidioidomycosis is a common cause of CAP in our patient population. In the absence of distinguishing clinical features, coccidioidal pneumonia can be identified only with appropriate laboratory studies.

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    IEEE 1987 Ultrasonics Symposium; 02/1987
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    ABSTRACT: Coccidioidomycosis (also known as San Joaquin Valley fever) is an occupational disease. Workers exposed to outdoor dust which contains spores of the soil-inhabiting fungus have a significantly increased risk of respiratory infection. In addition, people with compromised T-cell immunity, the elderly, and certain racial groups, particularly African-Americans and Filipinos, who live in regions of endemicity in the southwestern United States have an elevated incidence of symptomatic infection caused by inhalation of spores of Coccidioides posadasii or Coccidioides immitis. Recurring epidemics and escalation of medical costs have helped to motivate production of a vaccine against valley fever. The major focus has been the development of a defined, T-cell-reactive, recombinant protein vaccine. However, none of the products described to date have provided full protection to coccidioidal disease-susceptible BALB/c mice. Here we describe the first genetically engineered, live, attenuated vaccine that protects both BALB/c and C57BL/6 mice against coccidioidomycosis. Two chitinase genes (CTS2 and CTS3) were disrupted to yield the attenuated strain, which was unable to endosporulate and was no longer infectious. Vaccinated survivors mounted an immune response characterized by production of both T-helper-1- and T-helper-2-type cytokines. Histology revealed well-formed granulomas and markedly diminished inflammation. Significantly fewer organisms were observed in the lungs of survivors than in those of nonvaccinated mice. Additional investigations are required to further define the nature of the live, attenuated vaccine-induced immunity against Coccidioides infection.
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    ABSTRACT: Coccidioidomycosis is a fungal infection caused by Coccidioides spp., a fungus endemic to the southwestern USA. Immunocompromised patients with coccidioidomycosis often present with atypical manifestations. We provide clinical, diagnostic, and management approaches for clinicians in nonendemic areas who might encounter coccidioidomycosis in transplant recipients. With preemptive screening, heightened awareness, and targeted prophylaxis, the incidence of coccidioidomycosis in transplant recipients has decreased to 1-3% in endemic areas. Dissemination and mortality continues to be clinically significant (about 30%). Serological findings are often unreliable in transplant recipients, necessitating invasive procedures for a tissue or microbiological diagnosis. Management recommendations are similar to those for immunocompetent hosts, except that transplant patients may require more prolonged therapy and secondary prophylaxis to prevent reactivation. The exact risk of donor-derived coccidioidomycosis is unknown. Routine antifungal prophylaxis is not currently recommended for transplant recipients visiting or relocating to endemic areas. Transplant recipients who travel to or reside part-time or full-time in endemic areas are at risk for both primary and reactivated coccidioidomycosis. Clinicians in nonendemic areas should be aware that early diagnosis followed by prompt antifungal therapy could be lifesaving. Prophylactic strategies can prevent reactivation in select circumstances.
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