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ページの作成:「*most deadly fungus in the world **''Coccidioides immitis'' & ''C. posadasii'' **[https://www.niid.go.jp/niid/ja/kansennohanashi/401-coccidioidomycosis-intro.html コ…」
*most deadly fungus in the world
**''Coccidioides immitis'' & ''C. posadasii''
**[https://www.niid.go.jp/niid/ja/kansennohanashi/401-coccidioidomycosis-intro.html コクシジオイデス症とは｜感染研]
==Distribution==
*southwest US
**70% of US cases concentrated in AZ, 20% in CA
**geographical association of creosote bush in AZ
**San Joaquin Valley in CA, "Valley fever"
***spores fly into town from deserts miles away
*some central and south American countries
==Pathogen==
*live in 10-20 cm underground soil
*dimorphic fungus
**filamentous in environment - arthroconidia
***cultured coccidia is impossible to distinguish from other filamentous fungi macroscopically
**yeast form in human parasitism - spherules
*incubation 1-4 weeks
*recurrence/reactivation possible for years even in decades
*all healthy people susceptible
*African American > Hispanic > Asian > Caucasian
*very short time exposure may cause disease
**even during transit at an airport in endemic area
**earthquake in 1994 developed massive landslide in the valley, resulting in dispersion and spreading of spores and large outbreak of Valley fever
**if accidentally cultured on petri dish, it is quite easily dispersed in aerosol = laboratory infection, highly biohazardous
*no human to human transmission
**the yeasts proliferate by endospore forming, clearly different from filamentous proliferation by sporing in environment
**lab infection including autopsy or inappropriate handling of specimen possible
==Clinical features==
*acute pulmonary form
**most common
**influenza like
**erythema nodosum
***EN in coccidiomycosis is allergic reaction, not infectious
**spontaneous relief in most cases
*diffuse pneumonia form
**fatal
**mostly in immunocompromised
*chronic pulmonary form
**most common in Japan cases
**cough, hemoptysis
**weight loss
**low grade fever
**or asymptomatic with incidental discovering of lung lesions
**cavity development possible leading to rupture of the cavity and pneumothorax
*disseminated form
**meninge - mild symptoms
**skin
**bone
**multiple organs in the most severe case
*50-60% acute form
*10% chronic form
*1% disseminated form
==Diagnosis==
*pathology of skin/lung
*smear of sputum
*culture is very dangerous except for special laboratory
*serology for antibody or antigen
*PCR
==Treatment==
*no treatment and follow up in asymptomatic/mild/no risk factor
*azoles - fluconazole, itraconazole, posazonacol
*liposomal AMPH-B in serious and pregnant
**''Coccidioides immitis'' & ''C. posadasii''
**[https://www.niid.go.jp/niid/ja/kansennohanashi/401-coccidioidomycosis-intro.html コクシジオイデス症とは｜感染研]
==Distribution==
*southwest US
**70% of US cases concentrated in AZ, 20% in CA
**geographical association of creosote bush in AZ
**San Joaquin Valley in CA, "Valley fever"
***spores fly into town from deserts miles away
*some central and south American countries
==Pathogen==
*live in 10-20 cm underground soil
*dimorphic fungus
**filamentous in environment - arthroconidia
***cultured coccidia is impossible to distinguish from other filamentous fungi macroscopically
**yeast form in human parasitism - spherules
*incubation 1-4 weeks
*recurrence/reactivation possible for years even in decades
*all healthy people susceptible
*African American > Hispanic > Asian > Caucasian
*very short time exposure may cause disease
**even during transit at an airport in endemic area
**earthquake in 1994 developed massive landslide in the valley, resulting in dispersion and spreading of spores and large outbreak of Valley fever
**if accidentally cultured on petri dish, it is quite easily dispersed in aerosol = laboratory infection, highly biohazardous
*no human to human transmission
**the yeasts proliferate by endospore forming, clearly different from filamentous proliferation by sporing in environment
**lab infection including autopsy or inappropriate handling of specimen possible
==Clinical features==
*acute pulmonary form
**most common
**influenza like
**erythema nodosum
***EN in coccidiomycosis is allergic reaction, not infectious
**spontaneous relief in most cases
*diffuse pneumonia form
**fatal
**mostly in immunocompromised
*chronic pulmonary form
**most common in Japan cases
**cough, hemoptysis
**weight loss
**low grade fever
**or asymptomatic with incidental discovering of lung lesions
**cavity development possible leading to rupture of the cavity and pneumothorax
*disseminated form
**meninge - mild symptoms
**skin
**bone
**multiple organs in the most severe case
*50-60% acute form
*10% chronic form
*1% disseminated form
==Diagnosis==
*pathology of skin/lung
*smear of sputum
*culture is very dangerous except for special laboratory
*serology for antibody or antigen
*PCR
==Treatment==
*no treatment and follow up in asymptomatic/mild/no risk factor
*azoles - fluconazole, itraconazole, posazonacol
*liposomal AMPH-B in serious and pregnant
