S6.4c Primary cutaneous implantation coccidioidomycosis

Abstract

S6.4 One health approach for endemic mycoes in the Americas, September 22, 2022, 4:45 PM - 6:15 PMObjectiveTo present a series of cases of primary cutaneous coccidioidomycosis, to highlight this mycosis that can start as cutaneous implantation, after trauma, and to emphasize the classification criteria.MethodsA series of cases of primary cutaneous coccidioidomycosis will be presented, all of them confirmed by mycological studies, fresh examinations, stains, and cultures, as well as their molecular identification; also confirmed by histopathology.ResultsA series of 22 cases of primary cutaneous coccidioidomycosis is presented, 16 (72.8%) in men, 6 (27.2%) in women. With an average age of 35.2 years, with the lowest case in a 14-year-old child and the highest at 72 years. All from rural and endemic areas. A total of 11 (50%) with fieldwork and the rest due to various injuries. The etiological agent was isolated in all of them: Coccidiodes posadasii in 16 (72.8%), C. immits in 3 and one by Coccidiodes sp. 20 cases were managed with itraconazole, with an average of 8 months and two more with a cycle of amphotericin B and subsequent itraconazole. Clinical and mycological cure was obtained in all.DiscussionPrimary cutaneous coccidioidomycosis, is considered an implantation mycosis, similar to other endemic ones, it occurs between 2%-10% of cases. It begins after trauma that inoculates the fungus, such as a primary chancre. To confirm that it is a primary form, Wilson's criteria must be met: the presence of skin trauma, regional lymphadenopathy, no evidence of pulmonary involvement, positive intradermal reaction, and low antibody titers. It may present auto involution and in immunosuppressed patients, it can spread.ConclusionThe initial cutaneous form of coccidioidomycosis is rare, usually seen in patients living in endemic areas, and usually present in patients with rural occupations. It has a variety of clinical forms, being confused with many diseases. Its diagnosis is simple, being the biopsy the most used, and it must be confirmed by mycological tests. It has a good prognosis and its main management is with itraconazole.