“…The manifestations appear between 10 and 15 days after exposure to the fungus, and the intensity of the symptoms depends directly on the infective load, ranging from the flu to a severe, nonspecific respiratory infection, accompanied by high fever, chest pain and cough with or without expectoration, as well as by general symptoms or allergic manifestations, particularly erythema nodosum [20]. Primary pulmonary coccidioidomycosis generally resolves spontaneously within 30-60 days, even without antifungal treatment, and patients retain lifelong immunity to exogenous infection [20,21]. In contrast, people with compromised immune systems such as patients with lymphoma, organ transplants or AIDS are more likely to develop severe pneumonia and disseminated infection [11,12,22,23] and particularly susceptible to chronic forms of pulmonary disease [24,25].…”
Coccidioidomycosis is an endemic mycosis in the southwest of the United States of America, northwestern Mexico and parts of Central and South America. Although this mycosis is infrequent outside the endemic zones and usually mild in immune competent individuals, it could be a lethal complication in the immunosuppressed patient. People who live in or travel to an endemic region can become infected and the time-frame for clinical appearance and severity correlates with the underlying immune status. In endemic regions, in which the levels of suspicion are high, this infection has been described after lung, kidney, heart and liver transplantation with an incidence of 1-7% and a concerning mortality rate of 20-50%. In non-endemic areas, the low level of suspicion is associated with a delay in the diagnosis and an even higher morbi-mortality. This work presents a case of early post-transplant pulmonary coccidioidomycosis in a renal recipient who was born and lives in a non-endemic zone, in which an aggressive diagnostic approach allowed an early diagnosis and biopsy-driven anti-mycotic treatment. This case highlights the changing landscape of traditionally well-delimited endemic areas and the need for a higher level of suspicion when transplant patients develop non-specific sings of a postoperative pulmonary infection.
“…The manifestations appear between 10 and 15 days after exposure to the fungus, and the intensity of the symptoms depends directly on the infective load, ranging from the flu to a severe, nonspecific respiratory infection, accompanied by high fever, chest pain and cough with or without expectoration, as well as by general symptoms or allergic manifestations, particularly erythema nodosum [20]. Primary pulmonary coccidioidomycosis generally resolves spontaneously within 30-60 days, even without antifungal treatment, and patients retain lifelong immunity to exogenous infection [20,21]. In contrast, people with compromised immune systems such as patients with lymphoma, organ transplants or AIDS are more likely to develop severe pneumonia and disseminated infection [11,12,22,23] and particularly susceptible to chronic forms of pulmonary disease [24,25].…”
Coccidioidomycosis is an endemic mycosis in the southwest of the United States of America, northwestern Mexico and parts of Central and South America. Although this mycosis is infrequent outside the endemic zones and usually mild in immune competent individuals, it could be a lethal complication in the immunosuppressed patient. People who live in or travel to an endemic region can become infected and the time-frame for clinical appearance and severity correlates with the underlying immune status. In endemic regions, in which the levels of suspicion are high, this infection has been described after lung, kidney, heart and liver transplantation with an incidence of 1-7% and a concerning mortality rate of 20-50%. In non-endemic areas, the low level of suspicion is associated with a delay in the diagnosis and an even higher morbi-mortality. This work presents a case of early post-transplant pulmonary coccidioidomycosis in a renal recipient who was born and lives in a non-endemic zone, in which an aggressive diagnostic approach allowed an early diagnosis and biopsy-driven anti-mycotic treatment. This case highlights the changing landscape of traditionally well-delimited endemic areas and the need for a higher level of suspicion when transplant patients develop non-specific sings of a postoperative pulmonary infection.
“…One patient developed pericarditis without pulmonary involvement [ 35 ]. Although there are no official clinical-epidemiological data, the scientific literature indicates that only two cases of acute pulmonary disease evolved to death, despite antifungal treatment [ 63 , 69 ]. Most patients were treated with deoxycolate amphotericin B and oral fluconazole; a minority of patients were treated with only one of these drugs alone.…”
Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.
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