Coccidioidomycosis disseminated

Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (duration >1 month) Cytomegalovirus disease (other than liver, spleen, or nodes)... 

Coccidioidomycosis is caused by infection with Coccidioides immitis. The endemic regions encompass the semi-arid regions of the southwestern United States from California to Texas, known as the Lower Sonoran Zone. It encompasses a spectrum of illnesses ranging from primary uncomplicated respiratory tract infection that resolves spontaneously to progressive pulmonary or disseminated infection. 

Therapy of coccidioidomycosis is difficult, and the results are unpredictable. Only 5% of infected persons require therapy. Candidates for therapy include those with severe primary pulmonary infection or concurrent risk factors (e.g., human immunodeficiency virus infection, organ transplant, or high doses of glucocorticoids), particularly patients with high complement fixation antibody titers in whom dissemination is likely. 

Amphotericin-B, an amphoteric polyene macrolide remains the most effective for severe systemic mycoses. It is indicated for systemic mycoses such as disseminated candidiasis, cryptococcosis, aspergillosis, mucormycosis, coccidioidomycosis, histoplasmosis, extracutaneous sporotrichosis and blastomycosis. It is a fungicidal antibiotic without antibacterial activity. It binds to ergosterol in the... 

Patients with HIV infection are at risk of developing disseminated histoplasmosis and coccidioidomycosis. In otherwise healthy people such infections are usually subclinical, or self-limiting within the lungs. 

Itraconazole is most useful in the long-term suppressive treatment of disseminated histoplasmosis in AIDS and in the oral treatment of nonmeningeal, non-life-threatening blastomycosis. It appears to be the drug of choice for all forms of sporotrichosis except meningitis and may have a lower relapse rate in the treatment of disseminated coccidioidomycosis than does fluconazole. 

Cryptococcosis blastomycosis systemic candidiasis disseminated forms of moniliasis, coccidioidomycosis, and histoplasmosis zygomycosis sporotrichosis and aspergillosis (Fungizone) IV Infusion Dosage based on patient tolerance, severity of infection. Initially, 1-mg test dose is given over 20-30 min. If test dose is tolerated, 5-mg dose may be given the same day. Subsequently, increases of 5 mg/dose are made q 12-24h until desired daily dose is reached. Alternatively, if test dose is tolerated, a dose of 0.25 mg/kg is given same day increased to 0.5 mg/kg the second day. Dose increased until desired daily dose reached. Total daily dose 1 mg/kg/day up to 1.5 mg/kg every other day. Do not exceed maximum total daily dose of 1.5 mg/kg. 

Coccidioidomycosis Lungs, skin, subcutaneous tissues may form disseminated lesions throughout the body Amphotericin B Fluconazole, itraconazole... 

Coccidioides immitis is a dimorphic fungus that grows in soil in much of the southwestern United States infection results from inhalation of airborne C. immitis arthroconidia. Coccidioidomycosis is not transmitted from person to person. Approximately 60% of infected persons are asymptomatic the remainder can develop a spectrum of disease from mild influenza-like illness to pneumonia to disseminated disease, including meningitis. Because the incubation period for this infection ranges from 1 to 4 weeks, persons who may... 

In disseminated coccidioidomycosis (A. Posada, 1894), lung involvement is predominant however, in 45-60% of cases, autopsy findings showed the liver to be affected as well. The principal manifestations are granulomas... 

Coodley, E.L. Disseminated coccidioidomycosis diagnosis by liver biopsy. Gastroenterology 1967 53 947 -952... 

Dodd, L.G., Nelson, S.D. Disseminated coccidioidomycosis detected by percutaneous liver biopsy in a liver transplant recipient. Amer. J. Clin. Pathol. 1990 93 141-144... 

Howard, P.F., Smith, J.W. Diagnosis of disseminated coccidioidomycosis by liver biopsy. Arch. Intern. Med. 1983 143 1335-1338... 

Coccidioidomycosis is caused by Coccidioides immitis and is endemic in some parts of the southwestern United States. It may cause nonspecific symptoms, acute pneumonia, or chronic pulmonary or disseminated disease. Primary pulmonary disease (unless severe) frequently is not treated, whereas extrapulmonary disease is treated with amphotericin B, and meningitis is treated with fluconazole. 

Although generally considered to be a regional disease, coccidioidomycosis has increased in importance in recent years because of the increased tourism and population in endemic areas, the increased use of immunosuppressive therapy in transplantation and oncology, and the AIDS epidemic. Although there is no racial, hormonal, or immunologic predisposition for acquiring primary disease, these factors affect the risk of subsequent dissemination of disease (Table 119-4). 

TABLE 119—4. Risk Factors for Severe, Disseminated Infection with Coccidioidomycosis... 

Disseminated disease occurs in less than 1 % of infected patients. The most common sites for dissemination are the skin, lymph nodes, bone, and meninges, although the spleen, Uver, kidney, and adrenal gland also may be involved. Occasionally, miliary coccidioidomycosis occurs, with rapid, widespread dissemination, often in concert with positive blood cultures for C. immitis. Patients with AIDS frequently present with miliary disease. Coccidioidomycosis in AIDS patients appears to be caused by reactivation of disease in most patients. 

Coccidioidomycosis (fever, chills, cough). Abraded Skin days Disseminated <... 

Disseminated coccidioidomycosis has been reported in a patient with Crohn s disease receiving adalimumab [34 ]. 

Mitter SS, Derhovanessian A, Hillman JD, Uslan DZ. Disseminated coccidioidomycosis in a patient managed with adalimumab for Crohn s disease. Nat Rev Gastroenterol Hepatol 2010 7(4) 231-5. 

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