Primary cutaneous coccidioidomycosis: a review of the literature and a report of a new case

Carroll, G. F.

doi:10.1001/archderm.113.7.933

Cited by 12 publications

(7 citation statements)

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“…Primary cutaneous coccidioidomycosis is characterized by a painful suppurative lesion at the site of inoculation, often with regional lymphadenopathy. Of the 18 cases reported as of 1977, all but 2 have remained localized (41).…”

Section: Categories Of Diseasementioning

confidence: 99%

Coccidioidomycosis: Host Response and Vaccine Development

2004

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Coccidioidomycosis is caused by the dimorphic fungi in the genus Coccidioides. These fungi live as mycelia in the soil of desert areas of the American Southwest, and when the infectious spores, the arthroconidia, are inhaled, they convert into the parasitic spherule/endospore phase. Most infections are mild, but these organisms are frank pathogens and can cause severe lethal disease in fully immunocompetent individuals. While there is increased risk of disseminated disease in certain racial groups and immunocompromised persons, the fact that there are hosts who contain the initial infection and exhibit long-term immunity to reinfection supports the hypothesis that a vaccine against these pathogens is feasible. Multiple studies have shown that protective immunity against primary disease is associated with T-helper 1 (Th-1)-associated immune responses. The single best vaccine in animal models, formalin-killed spherules (FKS), was tested in a human trial but was not found to be significantly protective. This result has prompted studies to better define immunodominant Coccidioides antigen with the thought that a subunit vaccine would be protective. These efforts have defined multiple candidates, but the single best individual immunogen is the protein termed antigen 2/proline-rich antigen (Ag2/PRA). Studies in multiple laboratories have shown that Ag2/PRA as both protein and genetic vaccines provides significant protection against mice challenged systemically with Coccidioides. Unfortunately, compared to the FKS vaccine, it is significantly less protective as measured by both assays of reduction in fungal CFU and assays of survival. The capacity of Ag2/PRA to induce only partial protection was emphasized when animals were challenged intranasally. Thus, there is a need to define new candidates to create a multivalent vaccine to increase the effectiveness of Ag2/PRA. Efforts of genomic screening using expression library immunization or bioinformatic approaches to identify new candidates have revealed at least two new protective proteins, expression library immunization antigen 1 (ELI-Ag1) and a β-1,3-glucanosyltransferase (GEL-1). In addition, previously discovered antigens such as Coccidioides-specific antigen (CSA) should be evaluated in assays of protection. While studies have yet to be completed with combinations of the current candidates, the hypothesis is that with increased numbers of candidates in a multivalent vaccine, there will be increased protection. As the genome sequences of the two Coccidioides strains which are under way are completed and annotated, the effort to find new candidates can increase to provide a complete genomic scan for immunodominant proteins. Thus, much progress has been made in the discovery of subunit vaccine candidates against Coccidioides and there are several candidates showing modest levels of protection, but for complete protection against pulmonary challenge we need to continue the search for additional candidates

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Section: Categories Of Diseasementioning

confidence: 99%

Coccidioidomycosis: Host Response and Vaccine Development

2004

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“…[134][135][136][137][138][139][140][141][142] A comprehensive review of the subject has recently been published. 141 Traumatic inoculation of the organism results from direct contact with a source in the environment or in the laboratory.…”

Section: Primary Cutaneous Infectionmentioning

confidence: 99%

“…141 Traumatic inoculation of the organism results from direct contact with a source in the environment or in the laboratory. Primary cutaneous infections have been reported in agricultural workers, 136 laboratory workers, 137,139,142 an embalmer, 140 and in persons suffering splinter injuries or lacerations. 134,135,138 Primary cutaneous coccidioidomycosis typically manifests as an ulcerated nodule on an extremity, although other sites may also be affected (Fig 9).…”

Section: Primary Cutaneous Infectionmentioning

confidence: 99%

Coccidioidomycosis: A review and update

DiCaudo

2006

Journal of the American Academy of Dermatology

111

104

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“…9 A variety of cutaneous signs may be seen in association with coccidioidomycosis. [16][17][18][19] Both reactive and organism-specific lesions may occur (Table). Organismspecific lesions contain Coccidioides, which may be identified in skin biopsy specimens by routine histochemical stains, special fungal stains, or fungal cultures.…”

Section: Commentmentioning

confidence: 99%