Disseminated coccidioidomycosis in immunocompetent patients in non-endemic areas: a case series and literature review

Coccidioides-Induced Pyopneumothorax in an Immunocompetent Patient

“…Previous studies have suggested some individuals are at an increased risk of developing symptomatic coccidioidomycosis and worse outcomes, including those with immunocompromised states, especially males aged >60; of African American, Hispanic, or Southeast Asian heritage; uncontrolled diabetes; living in endemic areas; smoking; and pregnant women [10][11][12][13][14][15]. Our patient did have some risk factors, including being male, Hispanic, living in an endemic area, and having a history of marijuana use.…”

Pulmonary infections in the returning traveler

“…Acquisition of these infections usually involves exposure/inhalation of specific fungal forms in endemic areas and may be associated with particular risk factors or activities. In immunocompetent travelers, these infections may have mild, self-limiting presentations or even be asymptomatic, although disseminated disease has been described [43,44]. The possibility of reactivation of latent fungal infections even years after exposure should be considered when assessing patients with pneumonia.…”

“…Progressive pneumonia with extrapulmonary manifestations such as cutaneous, lymph node, and CNS involvement in travelers should alert professionals to the possibility of coccidioidomycosis. Although immunocompetent individuals usually present with self-limiting respiratory symptoms, disseminated disease may occur, often leading to diagnostic conundrums, delays, and misidentification of this fungal infection with other conditions such as community-acquired pneumonia, TB, and metastatic malignant disease [44]. Travel-related coccidioidomycosis should therefore be suspected in both immunocompetent and immunosuppressed individuals, associated with both pulmonary as well as mixed presentations with extrapulmonary involvement and dissemination, following exposure in desert areas of the southwestern USA, parts of Mexico or Central and South America [50].…”

Musculoskeletal and CNS coccidiomycosis in an individual with multiple sclerosis on fingolimod – A case report

“…However, around 5 % of diagnosed cases present with dissemination of the disease outside of confines of the lungs [6] . Patients with the greatest risk for disseminated disease typically are those that are immunocompromised such occurs with AIDS, some forms of chemotherapy, or organ transplantation-related immunosuppression [7] ; however, immunocompetent hosts are also at risk [8] . Cases are associated with residence or travel to endemic areas, such as the Southwest United States and parts of Central and South America [9] .…”