Review Question - QID 106424

Based on the location of his camping trip along with the pathology slide demonstrating a spherule filled with endospores, this male is presenting with coccidioidomycosis.

Coccidioidomycosis (aka "Valley fever" or "San Joaquin Valley fever") is caused by Coccidioides immitis which is a dimorphic fungi growing as a mold at 20 deg C and as a spherule at 37 deg C (Note: all other systemic mycoses grow as yeast at 37 deg C.) C. immitis is endemic to the Southwestern part of the United States, specifically California and Arizona, as well as the northern parts of Mexico. It causes pneumonia and meningitis and can disseminate to other parts of the body such as the skin and bones.

Bayer reviews the presentation of primary pulmonary coccidioidomycosis. The patient typically presents with a fever, chest pain, and a nonproductive cough but in most cases the patient recovers spontaneously. If symptoms persist for more than 8 weeks or there are continuous positive sputum cultures, it is usually indicative that the infection has spread and requires antifungal therapy.

Galgiani et al. discusses the management of coccidioidomycosis, which requires the physician to identify the extent of the infection and the immunocompetency of the individual. For immunocompetent individuals with localized infection, they require periodic assessment as they will most likely spontaneously recover. For those who may be immunocompromised or with extensively spread infection, they may require antifungals. The initial therapy is either itraconazole or fluconazole. Amphotericin B is reserved for those with severe cases. The duration of therapy can range from several months to years and may be lifelong for those who may be immunocompromised or have repeated infections.

Figure A demonstrates the classic finding of a coccidioidomycosis spherule filled with endospores.

Incorrect Answers:
Answer 1: Candidiasis would most likely present in the case of an immunocompromised individual; in this case there is no mention of the individual being immunocompromised.
Answers 2 - 4: These diseases are typically not found in Arizona. Blastomycosis occurs in states east of the Mississippi River and central America, histoplasmosis occurs in the Mississippi and Ohio River Valleys, and paracoccidioidomycosis occurs in Latin America. Furthermore, they do not form spherules filled with endospores.