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Coccidioidomycosis - acute pulmonary

Definition

Acute pulmonary coccidioidomycosis is a lung infection caused by breathing in spores of Coccidioides immitis or Coccidioides posadasii, fungi found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

See also:

• Coccidioidomycosis
• Disseminated coccidioidomycosis
• Skin lesion of coccidioidomycosis

Causes, incidence, and risk factors

Coccidioides infection begins in the lungs after a person breathes in the spores.

Those who are at higher risk of developing more serious Coccidioides infection include:

• People of Native American, African, or Philippine descent
• Those with weakened immune systems due to AIDS, diabetes, or medications that suppress the immune system

Occasionally the infection may develop into a long-term (chronic) lung disease or can reactivate after a long latent period.

Traveling to an area where these fungi are found is a risk for coccidioidal infection. Areas in the U.S. include southwestern New Mexico, Arizona, California (especially the San Joaquin Valley), and western Texas.

Symptoms

Most of the time, people with this time of infection never have symptoms. In other people, the symptoms range from mild, cold- or flu-like symptoms to severe pneumonia.

If they occur, symptoms start about 5 to 21 days after you come into contact with the fungus. They may include:

• Chest pain (varies from mild to severe)
• Cough, possibly bloody
• Fever
• Headache
• Joint pain
• Rash, may be painful, red lumps, on lower legs (erythema nodosum)

Rarely, the infection spreads from the lungs through the bloodstream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs. See: Disseminated coccidioidomycosis

Signs and tests

The health care provider will perform a physical exam and listen to your lungs with a stethoscope. The following tests may be done:

• Biopsy of lymph node or lung
• Bronchoscopy
• Blood test for antibodies to the fungus
• Chest x-ray
• Chest CT scan
• Complete blood count (CBC)
• Sputum smear (KOH test or Papanicolaou stain)

Treatment

The acute form of coccidiodomycosis usually goes away without treatment. Your health care provider may recommend bedrest and treatment of flu-like symptoms until your fever disappears.

If you have a weakened immune system, you may need antifungal treatment with amphotericin B, fluconazole, or itraconazole. The best length of treatment with these medications has not been determined.

Support Groups

Expectations (prognosis)

In most cases, the outlook is good.

Complications

• Chronic pulmonary coccidioidomycosis
• Disseminated coccidioidomycosis

Calling your health care provider

Call your health care provider if:

• You have symptoms of coccidioidomycosis
• Your symptoms get worse or do not improve with treatment
• You develop new symptoms

Prevention

Avoiding travel to regions where this fungus is found will prevent this disorder. However, this is not practical or possible for many people. You should avoid contact with soil in these regions if you have a weakened immune system due to HIV or other conditions.

References

Davies SF, Knox KS, Serosi GA. Fungal infections. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 34.

Galgiani JN. Coccidioidomycosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 354.