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Coccidioidomycosis

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CoccidioidomycosisOverviewThe OrganismSlide 4Life CycleHistoryHistoryEpidemiologyGeographic DistributionEndemic Areas in the U.S.Risk Factors for InfectionRisk Factors for InfectionMorbidity and Mortality: HumansNumber of US Valley Fever Cases, 1995-2011Geographic Distribution of Coccidioidomycosis in persons >65 years of age, U.S., 1999-2008TransmissionSlide 17Slide 18Disease in HumansIncubation Period in HumansPrimary Pulmonary CoccidioidomycosisSlide 22Progressive Pulmonary CoccidioidomycosisDisseminated CoccidioidomycosisDisseminated Coccidioidomycosis: Coccidioidal MeningitisPrimary Cutaneous CoccidioidomycosisCoccidioidomycosis in the ImmunosuppressedDiagnosis in Humans: Direct ObservationDiagnosis in Humans: CultureDiagnosis in Humans: SerologyDiagnosis in Humans: Additional TestsTreatment in HumansDisease in AnimalsSpecies AffectedIncubation in AnimalsDisease in DogsMorbidity and Mortality: DogsDisease in CatsMorbidity and Mortality: CatsDisease in HorsesDisease in Other SpeciesMorbidity and Mortality: Horses, Ruminants, PigsDisease in Other AnimalsPost Mortem LesionsDiagnosis in AnimalsDiagnosis in Animals: Direct ObservationDiagnosis in Animals: CultureDiagnosis in Animals: SerologyTreatment in AnimalsPrevention and ControlPrevention in HumansSlide 52Prevention in AnimalsDisinfectionAdditional ResourcesAcknowledgmentsCoccidioidomycosis Valley Fever, San Joaquin Valley Fever, Desert Rheumatism, Posadas-Wernicke Disease, Coccidioidal GranulomaOverview•Organism•History•Epidemiology•Transmission•Disease in Humans•Disease in Animals•Prevention and ControlCenter for Food Security and Public Health, Iowa State University, 2013THE ORGANISMThe Organism•Dimorphic, soil-borne fungi–Coccidioides immitis–C. posadasii•Minor differences–None in pathogenicity •Grows in semiarid regions–Esp. with sandy, alkaline soil–Also extreme temperaturesand high salinityCenter for Food Security and Public Health, Iowa State University, 2013Life Cycle•Two asexual reproductive structures–Arthroconidia•Grows in environment•Infectious to humans/animals–Spherules with endospores•In the bodyCenter for Food Security and Public Health, Iowa State University, 2013HISTORYHistory •Discovered in Argentina, 1892–Soldier, cutaneous lesions•Additional research in areas of endemicity–San Joaquin Valley•Migrants from the Midwest–WW II military recruits, prisoners of war, Japanese held in internment camps•Cases continue to occur in U.S. Center for Food Security and Public Health, Iowa State University, 2013EPIDEMIOLOGYGeographic Distribution•Western hemisphere–U.S.–Mexico–Central and South America •Endemic in southwestern U.S.–Arizona–New Mexico–West Texas–Central and Southern California Center for Food Security and Public Health, Iowa State University, 2013Endemic Areas in the U.S.Center for Food Security and Public Health, Iowa State University, 2013Risk Factors for Infection •Dust exposure a risk factor•Occupational groups at risk–Farmers, construction workers•Weather-related peaks–Wet followed by dry, windy periods –Earthquakes, windstorms Center for Food Security and Public Health, Iowa State University, 2013Risk Factors for Infection •Immunocompromised persons at risk–HIV-1 patients with decreasedCD4 T cell counts –Organ transplant patients–Lymphoma patients–People receiving long-term corticosteroids–Pregnant women–ElderlyCenter for Food Security and Public Health, Iowa State University, 2013Morbidity and Mortality: Humans•Southwest U.S.–Prevalence 10-70% •Illness severity–60% cases asymptomatic to mild–40% cases become ill•90% infections limited to lungs•Case fatality rate–Varies with location of organismand treatment Center for Food Security and Public Health, Iowa State University, 2013Number of US Valley Fever Cases, 1995-2011Center for Food Security and Public Health, Iowa State University, 2013Geographic Distribution of Coccidioidomycosis in persons >65 years of age, U.S., 1999-2008Center for Food Security and Public Health, Iowa State University, 2013Baddley JW, Winthrop KL, Patkar NM et al. Geographic Distribution of Endemic Fungal Infections among Older Persons, United States. Emerging Infectious Diseases. 2011;17(9).TRANSMISSIONTransmission•Humans, animals= accidental hosts•Routes of transmission–Inhalation –Inoculation (penetrating objects)–Dust-covered fomites •Communicability–Direct transmission between peopleor animals very rare Center for Food Security and Public Health, Iowa State University, 2013TransmissionCenter for Food Security and Public Health, Iowa State University, 2013DISEASE IN HUMANSIncubation Periodin Humans•Primary pulmonary form–Usually 1-3 weeks•Disseminated disease, chronic pulmonary form–Can occur months to years after initial infection Center for Food Security and Public Health, Iowa State University, 2013Primary Pulmonary Coccidioidomycosis •Acute disease form–Most asymptomatic or mild•Symptomatic disease–Often flu-like–May resemble pneumonia–Skin lesions•10-50% of patients with pulmonary diseaseCenter for Food Security and Public Health, Iowa State University, 2013Primary Pulmonary Coccidioidomycosis •Severe disease more commonif immunosuppressed•Mild cases often self-limited•Pulmonary nodulesmay persist –Incidental finding onchest x-rays –Distinguish from other conditions Center for Food Security and Public Health, Iowa State University, 2013Progressive Pulmonary Coccidioidomycosis •Clinical signs do not resolve–Chronic and progressive disease•Lesions–Nodular or cavitary in lungs –Cavitary lung disease with fibrosis –Miliary pulmonary dissemination•Disease usually limited to respiratory tract Center for Food Security and Public Health, Iowa State University, 2013Disseminated Coccidioidomycosis•Small percentage of cases•Often acute–Can be rapidly fatal without treatment•May also progress slowly–Periods of remission and recurrence •Tissues affected–Skin, regional lymph nodes, bones, joints, visceral organs, testes–Clinical signs vary Center for Food Security and Public Health, Iowa State University, 2013Disseminated Coccidioidomycosis:Coccidioidal Meningitis •Symptoms–Fever, headache, cognitive impairment–Inflammation can lead to vasculitis, stroke, or hydrocephalus•Untreated cases–Death almost always within 2 years•Other possible outcomes–Encephalitis,


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