Extrapulmonary Coccidioidomycosis Research Articles

Testicular tumour: Unusual presentation of an unusual infectious disease

Background: Testicular tumour of Coccidioidomycosis is an extremely rare example of infectious disease. It usually affects the respiratory system especially in immunocompromised patients. Extrapulmonary Coccidioidomycosis accounts for 0.5% of cases with testicular involovement in 1.5% among them. Case Description: A 54 y gentleman presented with an increasing painless swelling in the left scrotum for 5 m with a history of diabetes mellitus for 9 y. Examination findings revealed an approximately 4.5 × 3 cm hard lump in the upper pole of the left testis with small hydrocele and varicocele. Laboratory values of serum AFP, β-hCG and LDH were within normal limits with high blood glucose level (351 mg/dl) and HBA1c (8.1). USG of the scrotum showed bilateral minimal hydrocele with left varicocele. CECT abdomen and pelvis showed bilateral hydrocele with normal testes, left varicocele and bilateral inguinal lymphadenopathy. Surgery was planned for excision of the lump with or without orchidectomy with inguinal lymph node biopsy via high inguinal approach. At surgery, an approximately 4 × 2 cm left spermatic cord hard tumour mass encircling the vessels and the vas deferens just proximal to the testis associated with thrombosis of the testicular vein, secondary varicocele, minimal hydrocele and multiple left inguinal lymph nodes was found. Excisional biopsy of the left spermatic cord mass and inguinal lymph nodes was done preserving the spermatic cord structures and the testis. Histopathological report showed reactive lymphadenitis from the inguinal lymph nodes and coccidioidomycosis with granulomatous lesion from the left spermatic cord mass. Treatment was started with a daily dose of 300 mg of Fluconazole for 6 m. After 2 w of initial therapy, serous collection which developed was drained and it took 3 m for the wound to heal. Discussion: Coccidioidomycosis is an infectious fungi which very rarely manifest as a surgical disease. Definitive diagnosis is with histopathological examination. Besides, other serological tests such as IgM, IgG antibodies, complement fixation test etc are supportive. Treatment consists of Fluconazole or Amphotericin B though duration is not standardized. Conclusion: Although uncommon, Coccidioidomycosis needs to be ruled out in testicular tumour especially in immunocompromised patients preventing unnecessary orchidectomy.

Extrapulmonary Coccidioidomycosis Among Children in Central California: A Retrospective Review.

The literature on pediatric extrapulmonary coccidioidomycosis is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis followed at a tertiary care center in central California. Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis diagnosed over 10 years (1/1/07-12/31/16). The median age was 9.7 years (interquartile range, 4.5-14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P = 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P = 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P = 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P = 0.04) and tended to have Coccidioides complement fixation titers ≥1:32 (89% vs. 72%, P = 0.04) compared with Hispanics. Extrapulmonary coccidioidomycosis in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.

Peritoneal and genital coccidioidomycosis in an otherwise healthy Danish female: a case report

BackgroundCoccidioidomycosis is a fungal infection that usually presents as a primary lung infection. The fungus is endemic to the Southwest United States of America, northern Mexico and parts of Central and South America the infection is rare outside these areas. However, some patients develop disseminated infection that can lie dormant for several years and can present itself in travelers. We report the first case of extra pulmonary Coccidioidomycosis in a non-immunocompromised individual in Denmark.Case presentationA 32 year old Danish woman presented at the Emergency department with abdominal pain. Computed tomography scan and ultrasound examination of the pelvis raised suspicion of salpingitis. A laparoscopy exposed a necrotic salpinx and several small white elements that resembled peritoneal carcinomatosis. Histological workup however determined that she suffered from disseminated coccidioidomycosis. The patient had lived 2 years in Las Vegas, in the United States of America, 7 years prior and had no memory of lung infection at the time.ConclusionsDisseminated coccidioidomycosis is rare in non-immunocompromised individuals. The patient in this case underwent several rounds of in vitro fertilization treatment in the years before admittance. We suspect that the hormonal treatment in combination with low-dose prednisolone may have triggered reemergence of the disease and present literature that support this.

Coccidioidal Endophthalmitis in Immunocompetent Person, California, USA

Coccidioidal Endophthalmitis in Immunocompetent Person, California, USA

The Utility of Fine Needle Aspiration for Diagnosis of Extrapulmonary Coccidioidomycosis: A Case Report and Discussion

Coccidioidomycosis typically presents as pneumonia, but rarely manifests as extrapulmonary disease. We describe a case of coccidioidal infection that presented as a neck mass and was diagnosed by fine needle aspiration (FNA). Initial clinical suspicion was for mycobacterial infection. Several modalities are available for the detection of Coccidioides species, but culture has been the mainstay of diagnosis. FNA provides a relatively noninvasive and effective modality for tissue-based diagnosis based on characteristic histological findings. It allows the additional advantage of early on-site identification, allowing for triage of the specimen, notification of laboratory staff and prompt initiation of treatment. The case herein described is intended to demonstrate an atypical presentation of extrapulmonary coccidioidomycosis and highlight the utility of FNA for diagnosis of such lesions. Clinicians should be aware of the unique advantages of FNA for evaluation of lesions of infectious etiology.

Coccidioidomycosis

Coccidioidomycosis is a common infectious disease in the southwestern United States. Although Coccidioides species are not endemic in other areas of the country, the rapid population growth in the southwestern United States in recent decades and the increase in tourism mean that many people travel to the Southwest and return home before developing the clinical syndrome of coccidioidomycosis. In this respect, coccidioidomycosis is a disease of national importance. It can occur in various manifestations: acute pneumonia, chronic progressive pneumonia, pulmonary nodules and cavities, extrapulmonary nonmeningeal disease, and meningitis. The diagnosis is often made on the basis of serologic findings. Treatment is usually with an azole or amphotericin B, depending on the clinical manifestations and the immune status of the host. We discuss the most common clinical manifestations, the best way to make the diagnosis, and the treatment of common infections.

Coccidioidomicosis extrapulmonar: Presentación de un caso y revisión de la literatura

Coccidioidomycosis is a deep mycotic infection endemic in the Southwestern part of the United States and Mexico and certain areas of Central and South America. The causative agents are fungi of the genus Coccidioides. Primary infection usually involves the lungs, and dissemination occurs in less than 1% of cases. While the extrapulmonary disease usually involves the skin, central nervous system, bones or joints, it can involve any tissue or organ. We present a case of extrapulmonary coccidioidomycosis in a 20-year-old male, in whom the diagnosis was made by a lymph node biopsy. His past history was not significant and the biopsy was performed because the physical findings were suggestive of lymphoma.

State‐of‐the‐Art Treatment of Coccidioidomycosis Skeletal Infections

Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Typically a respiratory illness, coccidioidomycosis can rarely present as extrapulmonary infection. Skeletal coccidioidomycosis occurs in 20% to 50% of disseminated infections. Skeletal coccidioidomycosis is a chronic and progressive infection that eventually results in bone destruction and loss of function and often involves adjacent structures, such as joints, muscles, and tendons and other soft tissues. Sinus tract formation may occur. This infection may be multifocal. Although radiographs, white blood cell count scans, and other imaging methods identify and define relevant abnormalities, histopathologic examination with culture of the involved bone is the only means to confirm the diagnosis. Serologic testing is adjunctive, and complement fixation titers can be evaluated serially to assess response to treatment. A number of studies addressing the efficacy of various antifungal agents have been performed, and the results of these studies as they pertain to skeletal coccidioidomycosis are summarized herein. Among the various studies, response rates ranged from 23% to 100%, but relapse was common. A combination of medical therapy-often, itraconazole or fluconazole-and surgical débridement is often needed to control skeletal coccidioidomycosis. Early diagnosis and treatment are critical to avoid long-term problems with chronically infected bones and joints. Anatomical issues, diagnostic studies, and data related to treatment of this form of extrapulmonary coccidioidomycosis are reviewed in this article.

COCCIDIOIDOMYCOSIS PRESENTING AS TESTICULAR MASS

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Oct 2001COCCIDIOIDOMYCOSIS PRESENTING AS TESTICULAR MASS JOSEPH C. LIAO and ROBERT E. REITER JOSEPH C. LIAOJOSEPH C. LIAO More articles by this author and ROBERT E. REITERROBERT E. REITER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65785-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "COCCIDIOIDOMYCOSIS PRESENTING AS TESTICULAR MASS." The Journal of Urology, 166(4), p. 1396 References 1 : Fungal infections of the genitourinary system: manifestations, diagnosis, and treatment. Urol Clin North Am1999; 26: 701. Google Scholar 2 : Genitourinary coccidioidomycosis. J Urol1988; 140: 370. Link, Google Scholar 3 : Genitourinary aspects of disseminated coccidioidomycosis. J Urol1975; 113: 82. Link, Google Scholar From the Department of Urology, University California Los Angeles School of Medicine, Los Angeles, California© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 166Issue 4October 2001Page: 1396 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.KeywordscoccidioidomycosisabnormalitiestestisMetricsAuthor Information JOSEPH C. LIAO More articles by this author ROBERT E. REITER More articles by this author Expand All Advertisement PDF downloadLoading ...

Coccidioidal Peritonitis Associated With Continuous Ambulatory Peritoneal Dialysis

We report the first three cases of peritonitis due to the fungus Coccidioides immitis occurring during continuous ambulatory peritoneal dialysis (CAPD). At the time of diagnosis, none of the patients had evidence of active infection outside of the peritoneal cavity. Clues suggesting the diagnosis including a previous history of pulmonary coccidioidomycosis, an excess number of eosinophils in the peritoneal fluid, and failure to respond to therapy directed against bacteria. C immitis in peritoneal fluid was more readily isolated on specific fungal culture media than on routine bacterial culture media. In no instances did potassium hydroxide (KOH) preparations of the fluid reveal fungi. Coccidioidal peritonitis during CAPD appears to be a localized form of extrapulmonary coccidioidomycosis that has a relatively benign course once the peritoneal catheter is removed.

Alternatives to the standardized laboratory branch complement fixation test for detection of antibodies to Coccidioides immitis.

Antibody titers to Coccidioides immitis, using coccidioidin antigen, were determined by three methods: the standardized Laboratory Branch complement fixation method (LBCF), a modified version of the Viral and Rickettsial Disease Laboratory complement fixation test (VRDL-CF), and a quantitative immunodiffusion test (QID). Of the 133 samples evaluated, 72 were negative by each method and 57 (42 serum samples, 15 cerebrospinal fluid samples) were positive by all three methods. Four additional specimens (1 serum sample, 3 cerebrospinal fluid samples) were positive by QID alone. All positive patients were diagnosed clinically as having pulmonary or extrapulmonary coccidioidomycosis or both. When titers from two methods were compared, the agreement within +/- 1 dilution was VRDL-CF/QID, 88.5%; VRDL-CF/LBCF, 85.2%; and LBCF/QID, 82.0%. The agreement of these methods within +/- 2 dilutions was VRDL-CF/QID, 98.4%; VRDL-CF/LBCF, 96.7%; and LBCF/QID, 93.4%. The VRDL-CF and QID methods are simpler to perform; however, they are yet unrecognized as suitable alternatives to the more cumbersome LBCF. Our data show that they should be considered as options for C. immitis serology.

Disseminated coccidioidomycosis in children

In an effort to define the importance of extrapulmonary coccidioidomycosis in the pediatric age group, we have studied 14 cases and reviewed the literature. The available data suggest that children are as susceptible to dissemination as are adults. Most children with disseminated coccidioidomycosis have evidence, either by history or chest radiographs, of preceding or concurrent pulmonary infection. The most common sites of dissemination are skin, subcutaneous tissue, bone, and meninges. Coccidioides immitis may be detected in tissues or body secretions by microscopic examination or by appropriate culture. Serologic tests are also useful in making the diagnosis and in following the course of the infection. Skin tests are often negative. Infection is progressive in 60% without antifungal therapy. Coccidioidomycosis of bone, skin, or subcutaneous tissue can be managed effectively with combined surgical and antifungal therapy. Meningitis is much more difficult to treat and is fatal in 50% of cases even when treated with amphotericin B.