Chapter 6. Outstanding Questions in the Field from the Curious Coccidioidomycosis


Raimunda Sâmia Nogueira Brilhante1, Marcos Fábio Gadelha Rocha1,2, José Júlio Costa Sidrim1
and Germana Costa Paixão1
1Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
2College of Veterinary, State University of Ceará, Fortaleza, Ceará, Brazil

Part of the book: The Book of Fungal Pathogens


Coccidioidomycosis is a fungal infection of the Western Hemisphere that is endemic in regions having low rainfall and soils with high salt content. Coccidioidomycosis was first described in 1892 by Alejandro Posadas in Argentina. The genus is dimorphic in nature, and in its asexual form it exists as a mycelium and spherules. Currently there are two species in the genus, called Coccidioides immitis and Coccidioides posadasii. The first one has been isolated in California while the second once has been found in other regions of the USA, as well as in some places in Central and South America. The two species can be distinguished by molecular techniques, but they are not routinely identified by species in the laboratory. The two species are indistinguishable by clinical manifestations and in vitro sensitivity tests. Most patients have self-limited or even asymptomatic infection/disease. Among those with symptomatic illness, 90% experience respiratory symptoms, with only 1% to 10% progressing to severe or disseminated illness. In most regions, the clinical diagnosis of coccidioidomycosis is based on direct examination of sputum and histopathological results of biopsies or autopsies. Coccidioidomycosis is definitively diagnosed when spherules are observed through pathological examination or fungal structures are observed in cultures. The use of serology requires an understanding of the tests involved, and the results must be interpreted in the context of time and ability to develop a host immune response. Azoles, especially fluconazole, are the mainstay of therapy. The need to treat mild lung disease is controversial, but treatment is mandatory in cases of severe or prolonged disease, dissemination, or severe immunosuppression. Severe infections may require amphotericin B. In this context, Coccidioidomycosis is best managed by a multidisciplinary team, where patients are monitored regularly.

Keywords: Coccidioides, coccidioidomycosis, etiology, pathophysiology, diagnosis, treatment


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