Abdominal and Pelvic Coccidioidomycosis
Section of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA.The American Journal of the Medical Sciences (Impact Factor: 1.39). 02/2011; 341(4):308-11. DOI: 10.1097/MAJ.0b013e3182058736
Coccidioidomycosis is a fungal infection endemic to the Southwestern United States that has a clinical presentation resembling community-acquired pneumonia. Disease occurs after inhalation of airborne arthroconidia. Dissemination to a variety of organ systems via hematogenous spread from a primary pulmonary focus may then occur. Coccidioidomycosis rarely involves the abdominal cavity. The authors review the spectrum of abdominal and pelvic presentations of coccidioidomycosis and report 6 unusual cases, including acute appendicitis, hepatitis and adnexal masses. Pathologists played a critical role in the diagnosis of these presentations by recognizing spherules in tissue. In only 2 of the cases were Coccidioides species cultured.
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ABSTRACT: Exposure to the fungal pathogen Coccidioides immitis in normal hosts causes primarily self-limited pulmonary disease. We report a case of an immunocompetent patient who developed a Coccidioides-associated iliopsoas abscess with rare intra-abdominal dissemination at least one decade after primary exposure in an area endemic for this fungus.
Article: Intra-abdominal fungal infections[Show abstract] [Hide abstract]
ABSTRACT: The clinical spectrum of intra-abdominal fungal infections has not been systematically analyzed in the literature. Even though intra-abdominal fungal infections have been recognized with increasing frequency in the recent years, most clinical experience is limited to case reports or uncontrolled case series. These infections are more common than clinically recognized disease. The clinical presentation varies broadly depending on the organism and host's immune status, but it is frequently severe, difficult to treat, and associated with significant morbimortality. Predisposing factors, clinical characteristics, and advances in the management are discussed. Intra-abdominal fungal infections are increasingly important in clinical practice. Early recognition and a combined treatment approach, usually consisting of surgical intervention and systemic antifungal therapy, are required for improved outcomes.
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ABSTRACT: An adult female, wild-caught red coachwhip snake (Masticophis flagellum piceus) was euthanized at the Phoenix Zoo due to severe neurologic signs. Necropsy and histopathology revealed an invasive liposarcoma of the vertebral column, which likely caused the neurologic signs. Histology of the small intestine revealed a granuloma with intralesional yeasts morphologically compatible with the genus Coccidioides. The diagnosis of coccidioidomycosis was confirmed with immunohistochemistry staining. Coccidioides posadasii is endemic to Arizona and is an important cause of disseminated fungal infections in mammals in this region. This is the first known report of intestinal coccidioidomycosis in a veterinary species and the second report of coccidioidomycosis in a reptile.
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