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Questions and Answers
What is the typical course of coccidioidomycosis in 50% of patients?
What is the typical course of coccidioidomycosis in 50% of patients?
- Requirement for immediate antifungal treatment
- Progressive symptoms requiring hospitalization
- Development of chronic pulmonary disease
- Spontaneous resolution (correct)
Which of the following is NOT a risk factor for coccidioidomycosis?
Which of the following is NOT a risk factor for coccidioidomycosis?
- Undergoing solid organ transplant
- Living in the Southwest US
- Being a lumberjack (correct)
- Having diabetes mellitus
Which laboratory finding is associated with coccidioidomycosis?
Which laboratory finding is associated with coccidioidomycosis?
- Osteolytic lesions in bone
- Eosinophilia and moderate leukocytosis (correct)
- Broad based budding
- Culture positivity in blood
What is the primary treatment for uncomplicated coccidioidomycosis?
What is the primary treatment for uncomplicated coccidioidomycosis?
What is the typical symptom presentation of blastomycosis?
What is the typical symptom presentation of blastomycosis?
Flashcards
Coccidioidomycosis (Valley Fever)
Coccidioidomycosis (Valley Fever)
A fungal infection caused by Coccidioides immitis or Coccidioides posadasii that is endemic to the southwestern United States, Mexico, and Central and South America. Usually acquired through inhalation of airborne spores, symptoms can range from mild, self-limiting illness to severe, life-threatening disease.
Blastomycosis
Blastomycosis
A fungal infection caused by Blastomyces dermatitidis, a dimorphic fungus found in soil and decaying wood. Typically acquired through inhalation of spores or skin contact with contaminated material.
Pulmonary Blastomycosis
Pulmonary Blastomycosis
A fungal infection that can be acquired through inhalation of spores, leading to lung involvement with symptoms such as fever, cough, and chest pain, but can also spread to other organs.
Disseminated Blastomycosis
Disseminated Blastomycosis
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Dimorphic Fungus
Dimorphic Fungus
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Study Notes
Coccidioidomycosis ("Valley Fever")
- Cause: Mold in soil, yeast in the body.
- Geographic Distribution: Southwest US (Arizona, Nevada), Mexico, Central America, South America.
- Transmission: Inhalation of airborne spores; rare from solid organ transplants.
- Course: Often subclinical, with spontaneous resolution in ~50% of patients; lifelong immunity often prevents recurrence.
- Risk Factors: Exposure to endemic area, dusty outdoor activities, HIV, diabetes mellitus (DM), advanced age, Black or Filipino ethnicity, and pregnancy.
- Symptoms (General): Fever, fatigue, headache, night sweats, weight loss, joint pain (arthralgias).
- Symptoms (Chest): Productive cough, shortness of breath (dyspnea), coughing up blood (hemoptysis), chest pain.
- Symptoms (Skin): Skin rash like erythema nodosum or erythema multiforme.
- Typical Presentation: May be observed in an Arizona man working in construction.
- Testing: IgM and IgG antibody titers, elevated white blood cells (moderate leukocytosis), and elevated eosinophils (eosinophilia), imaging like X-rays or CT scans.
- Treatment (uncomplicated): Spontaneous resolution common; consider itraconazole (200 mg by mouth twice daily) for 6 months.
- Treatment (progressive): Amphotericin B intravenously until antibody titers decline.
Blastomycosis
- Cause: Mold in soil and water.
- Geographic Distribution: Ohio River Basin, Mississippi River Basin, Great Lakes, and St. Lawrence River regions.
- Transmission: Inhalation of spores, skin trauma (e.g., from lumberjacking/wood-cutting).
- Pathophysiology: Exposure to contaminated soil or decomposing timber, inhalation of spores, skin trauma.
- Incubation period: 30-45 days.
- Symptoms (Pulmonary): Often initially asymptomatic in 50% of cases. When symptomatic, can include fever, sweating, cough, and nocturnal joint pain.
- Symptoms (Dissemination): Potential spread to bones, nervous system, additional lungs, liver, spleen, and kidneys.
- Diagnostic Imaging: Chest X-ray may reveal osteolytic lesions (bone breakdown).
- Diagnostic Testing: Microscopy to detect broad-based budding yeast, skin biopsy, and bone marrow aspirate.
- Treatment: Itraconazole (oral) for 6-12 months.
- Treatment (severe): Amphotericin B.
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