Coccidioidomycosis masquerading as skeletal tuberculosis: an imported case and review of coccidioidomycosis in India

Capoor, Malini R.; Sen, Bishwaroop; Varshney, Parul; Verghese, Mathew; Shivaprakash, M. R.; Chakrabarti, Arunaloke

doi:10.1177/0049475513512641

Cited by 12 publications

(6 citation statements)

References 11 publications

(17 reference statements)

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“…Antitubercular therapy on an empirical basis is common practice among high burden countries like India. 3,10 The present case highlights the problems encountered by the clinician while dealing with the emergence of newer disease entities hitherto considered 'geographically restricted'. Such diseases are further expected to rise in the non-endemic area due to the ever-changing demographics; therefore it is important for the clinicians to be aware of epidemiology of diseases not prevalent in their countries.…”

Section: Discussionmentioning

confidence: 90%

“…However, it is noteworthy that all 8 cases reported from India including the present one had history of travel to endemic zones in the USA; five to Arizona, two to California and one to both the states. 3,5 Contrary to usual fungal infections, 88% of the reported cases from India occurred in immunocompetent individuals that demonstrate the primary pathogenic potential of Coccidioidis spp. Of the reported cases, the present case is probably the only case of imported coccidioidomycosis in Indian patient whom dissemination was noted despite lack of any immunosuppressive illness.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, it is usual for cases reported from the non-endemic part of the world to have a history of travel to the afore-mentioned endemic zones. 3 Clinicoradiologically coccidioidomycosis mimics the more common mycobacterial infection tuberculosis (TB) and it is not uncommon to mis-diagnose and consequently mistreat the fungal infection using antitubercular therapy (ATT). The lacunae of misdiagnosis are partly attributed to the poor recognition of the disease by clinicians and lack of well-equipped mycological diagnostic facilities.…”

Section: Introductionmentioning

confidence: 99%

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A Diagnostic Predicament: Disseminated Coccidioidomycosis Mimics Tuberculosis

Agarwal¹,

Chaudhary²,

Khanna³

et al. 2022

The Indian Journal of Chest Diseases and Allied Sciences

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Coccidioidomycosis is a chronic granulomatous infection caused by dimorphic fungus Coccidioides spp. Sporadic cases of this infection have been reported globally in non-endemic regions those are primarily associated with travel to areas of high endemicity in the United States of America, Central and South America. The manifestations of coccidioidomycosis are not very different from tuberculosis (TB), and therefore, can be mis-diagnosed as TB, especially in areas with high prevalence of TB. We present a case of a middle-aged Indian male who travelled to USA and subsequently developed cough, fever, malaise, cutaneous nodules and discharging sinuses that were mis-diagnosed as TB; till a histopathological examination and fungal culture established the diagnosis of coccidioidomycosis of the lung with dissemination to the skin. He was successfully treated with oral itraconazole without any recurrence.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Diagnostic Predicament: Disseminated Coccidioidomycosis Mimics Tuberculosis

Agarwal¹,

Chaudhary²,

Khanna³

et al. 2022

The Indian Journal of Chest Diseases and Allied Sciences

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“…Chronic pneumonia and/or disseminated disease may follow [ 100 ]. About 1% of infected persons develop disseminated disease [ 56 , 57 , 60 ], which can involve the skin, joints, bones, central nervous system, or other organs and factors such as HIV, organ transplantation, diabetics mellitus, immunosuppressive agents, advanced age, pregnancy and Filipino and African ethnicity has an increased risk [ 99 , 101 ]. Chest imaging features may reveal cavities, opacities, pleural effusion and miliary nodules similar to chest radiological findings in TB thereby causing misdiagnosis of cases as shown in Table 6 , especially if out of an endemic area.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management

Ekeng

Davies

Osaigbovo

et al. 2022

JoF

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Fungal infections commonly present with myriad symptoms that mimic other clinical entities, notable amongst which is tuberculosis. Besides histoplasmosis and chronic pulmonary aspergillosis, which can mimic TB, this review has identified several other fungal infections which also do. A total of 80 individual cases misdiagnosed as TB are highlighted: aspergillosis (n = 18, 22.5%), histoplasmosis (n = 16, 20%), blastomycosis (n = 14, 17.5%), cryptococcosis (n = 11, 13.8%), talaromycosis (n = 7, 8.8%), coccidioidomycosis (n = 5, 6.3%), mucormycosis (n = 4, 5%), sporotrichosis (n = 3, 3.8%), phaeohyphomycosis (n = 1, 1.3%) and chromoblastomycosis (n = 1, 1.3%). Case series from India and Pakistan reported over 100 cases of chronic and allergic bronchopulmonary aspergillosis had received anti-TB therapy before the correct diagnosis was made. Forty-five cases (56.3%) had favorable outcomes, and 25 (33.8%) died, outcome was unclear in the remainder. Seventeen (21.3%) cases were infected with human immunodeficiency virus (HIV). Diagnostic modalities were histopathology (n = 46, 57.5%), culture (n = 42, 52.5%), serology (n = 18, 22.5%), cytology (n = 2, 2.5%), gene sequencing (n = 5, 6.3%) and microscopy (n = 10, 12.5%) including Gram stain, India ink preparation, bone marrow smear and KOH mount. We conclude that the above fungal infections should always be considered or ruled out whenever a patient presents with symptoms suggestive of tuberculosis which is unconfirmed thereby reducing prolonged hospital stay and mortalities associated with a delayed or incorrect diagnosis of fungal infections.

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“…In recent years, expansion in the rate of overseas travel history has led to a spike in the incidence of Coccidioidomycosis even in non-endemic regions of the world including the Indian subcontinent with atypical clinical manifestations 3 8–10. One such phenomenon is an extrapulmonary manifestation in the form of cervical lymphadenitis and to the best of our knowledge with only four similar cases available in literature 8 11.…”

Section: Introductionmentioning

confidence: 99%

Coccidioidomycosis lymphadenopathy: an unusual presentation

Sri

Vaithy

et al. 2023

BMJ Case Rep

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Coccidioidomycosis is known to occur around the western hemisphere. In tropical countries, the clinical presentation is atypical presenting with a superficial abscess preceded by respiratory tract involvement often mimicking tuberculosis. Eliciting a history of exposure and high suspicion is imperative for early diagnosis.In the present case report, a man in his early 30s presented with complaints of swelling over the neck for the past 2 months with a recent travel history. With a provisional clinical diagnosis of tuberculosis, a biopsy of the swelling revealed features of granulomas with non-caseating necrosis with Coccidioidomycosis organisms demonstrated by fungal stains. Fungal culture and serology reiterated Coccidioides and he recovered after a course of fluconazole.The case report concludes with a statement that Coccidioidomycosis is known to manifest with lymphadenitis mimicking tuberculosis and must be taken into account as one of the differentials. The current report is presented for its rarity in India with atypical presentation.

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Coccidioidomycosis masquerading as skeletal tuberculosis: an imported case and review of coccidioidomycosis in India

Cited by 12 publications

References 11 publications

A Diagnostic Predicament: Disseminated Coccidioidomycosis Mimics Tuberculosis

A Diagnostic Predicament: Disseminated Coccidioidomycosis Mimics Tuberculosis

Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management

Coccidioidomycosis lymphadenopathy: an unusual presentation

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