Cavitary pulmonary coccidioidomycosis: Pathologic and clinical correlates of disease

Department of Pathology, University of Arizona, Tucson, AZ 85724, USA.
Human pathology (Impact Factor: 2.77). 01/2014; 45(1):153-9. DOI: 10.1016/j.humpath.2013.08.014
Source: PubMed


Cavitary pulmonary coccidioidomycosis is a difficult diagnosis to establish due to the poor sensitivity of serological tests and rarity of culture from sputum. A pathologic and clinical analysis was performed of 21 consecutive patients with surgically resected cavities that proved to be coccidioidomycosis. Ten patients (48%) had serological evidence of Coccidioides infection, and 1 patient cultured Coccidioides spp. from sputum. The definitive diagnosis of coccidioidomycosis was made in the remaining 10 patients (48%) upon microscopic examination of tissue. The pleura showed fibrous pleuritis in 7 patients (33%) and eosinophilic pleuritis in 4 cases (19%); granulomas without microorganisms were demonstrated in 4 cases (19%). The cavity wall showed chronic inflammation and occasional giant cells but no granulomas and no microorganisms. The cavity contents included a mycetoma in 6 cases (28%); the cavity lining showed neutrophils and caseous necrosis; Coccidioides hyphae were present in 13 (62%) and spherules in 16 (76%) cases but often were rare. Adjacent lung showed lymphoid hyperplasia with chronic bronchiolitis in all cases; satellite granulomas with diagnostic spherules were variably present. The histopathology of cavitary coccidioidomycosis is strikingly variable depending on what area is sampled by biopsy, and microorganisms may be rare. This may explain the high rate of failure of diagnosis by fine needle aspiration and bronchoalveolar lavage. Pathologists in nonendemic areas must be aware of these findings, as this disease is now diagnosed worldwide.

4 Reads
  • Source

    04/2015; 10(4):182-183. DOI:10.13175/swjpcc025-15
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes. Published by Elsevier Inc.
    Immunology and allergy clinics of North America 08/2015; 35(3):493-522. DOI:10.1016/j.iac.2015.05.003 · 1.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Coccidioides immitis and C. posadasii are soil-dwelling fungi and the causative agents of coccidioidomycosis, a mycosis endemic to certain semi-arid regions within the Americas. The most common route of infection is by inhalation of airborne Coccidioides arthroconidia. Once a susceptible host inhales the conidia, a transition into mature endosporulated spherules can occur within the first five days of infection. For this study, we examined the host response in a murine model of coccidioidomycosis during a time-period of infection that has not been well characterized. We collected lung tissue and bronchoalveolar lavage fluids (BALF) from BALB/c mice that were infected with a C. immitis pure strain, a C. immitis hybrid strain, or a C. posadasii strain as well as uninfected mice. We compared the host response to each of the Coccidioides strains used in this study by assessing the level of transcription of select cytokine genes in lung tissues and characterized host and fungal proteins present in BALF. Host response varied depending on the Coccidioides strain that was used and did not appear to be overly robust. This study provides a foundation to begin to dissect the host immune response early in infection, to detect abundant Coccidioides proteins, and to develop diagnostics that target these early time points of infection. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Eukaryotic Cell 08/2015; 14(10). DOI:10.1128/EC.00122-15 · 3.18 Impact Factor
Show more