State‐of‐the‐Art Treatment of Coccidioidomycosis

Abstract

Coccidioidomycosis is a fungal infection common in the southwestern United States that is caused by the endemic Coccidioides species of fungus. Coccidioidal infections are generally manifested as self-limited respiratory illnesses, but affected patients rarely present with coccidioidomycosis in extrapulmonary locations. Skin and soft-tissue coccidioidomycosis may occur in 15% to 67% of patients with disseminated infection. Skin manifestations of coccidioidomycosis can either be reactive rashes, such as erythema multiforme or erythema nodosum associated with primary pulmonary infection, or they can be the result of extrapulmonary dissemination of the infection to the skin. As many as 90% of persons with disseminated infection to the skin have other extrapulmonary sites of infection, and the presence of coccidioidal skin lesions should prompt an investigation for other extrapulmonary foci of infection. Lymph nodes are a common site of extrapulmonary infection. Nearly every organ system and soft-tissue have been described as infected with Coccididioides species, but subcutaneous abscesses, phlegmon, and sinus tracts are not uncommon and often are themselves the result of coccidioidal infection in neighboring lymph nodes, bones, or joints. A biopsy of the abnormal area is the most direct way to diagnose skin and soft-tissue lesions. Fluconazole and itraconazole are preferred therapeutic agents, and surgical intervention may be required as an adjunctive measure. This article reviews the types and locations of disseminated infections, as well as diagnostic studies and treatment of this difficult-to-treat manifestation of coccidioidomycosis.

Card9- and MyD88-Mediated Gamma Interferon and Nitric Oxide Production Is Essential for Resistance to Subcutaneous Coccidioides posadasii Infection

“…The human skin is the most common extrapulmonary site of endemic mycoses and is frequently the first clinical manifestation of disseminated coccidioidomycosis (6,38). Although the skin is rarely the primary Coccidioides infection site, cutaneous infections have been reported among agricultural workers and laboratory personnel (12).…”

Erythema nodosum caused by ascariasis andChlamydophila pneumoniaepulmonary infection — a case report

“…Antibodies to this agent are found in 80% of older individuals (Braun-Falco et al, 2002). A patient with characteristics of erythema nodosum and skin coccidiomycosis of hypodermis was described by Blair (2007). Epidermophyton floccosum infection (Provini et al, 2003), Trichophyton mentagrophytes and Trichophyton rubrum infections during the course of scalp mycoses of a kerion type (Calista et al, 2001;Foti et al, 2001) have been described less frequently.…”

Pulmonary Coccidioidomycosis

“…43 Patients can also have lymphadenitis, joint involvement (particularly in the knees), 44 and skin involvement, which typically starts as cutaneous granulomatous lesions, subcutaneous soft tissue abscess, and deep ulcers. 45,46 Rare sites of dissemination include the small bowel, 47 genitourinary organs, 48 liver, and eyes. 49 Disseminated coccidioidomycosis can be isolated to one organ system or affect multiple systems at the same time.…”