RESUMO
We report 5 cases of coccidioidomycosis in animals that were acquired within Washington, USA, and provide further evidence for the environmental endemicity of Coccidioides immitis within the state. Veterinarians should consider coccidioidomycosis in animals with compatible clinical signs that reside in, or have traveled to, south central Washington.
Assuntos
Coccidioides/fisiologia , Coccidioidomicose/veterinária , Doenças do Cão/transmissão , Doenças dos Cavalos/transmissão , Animais , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Coccidioidomicose/microbiologia , Coccidioidomicose/transmissão , Doenças do Cão/diagnóstico , Doenças do Cão/microbiologia , Cães , Feminino , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/microbiologia , Cavalos , Humanos , Masculino , WashingtonRESUMO
Donor-derived coccidioidomycosis has caused unexpected morbidity and mortality in transplant recipients. All proven or probable reports of donor-derived coccidioidomycosis to the Disease Transmission Advisory Committee between 2005 and August 2012 were reviewed. Six reports of proven or probable coccidioidomycosis were discovered. In four of six, the infection was first detected at autopsy in the recipient. In two cases it was first identified in the donor. Twenty-one recipients received organs from these six donors. Transmission occurred in 43% at a median of 30 days posttransplant with a mortality rate of 28.5%. Eleven recipients received preemptive antifungals, seven did not receive treatment, and treatment information was not reported for three recipients. Five of seven who did not receive prophylaxis/treatment died and all 11 who received early therapy survived. Six deaths occurred 14 to 55 days after transplant, with a median of 21 days. For exposed recipients, donor-derived coccidioidomycosis is a significant cause of morbidity and mortality. Evidence of infection in one recipient should prompt immediate evaluation for treatment of all other recipients from the same donor as preemptive treatment was effective. Further studies are needed to decide whether all donors from endemic areas should have routine serologic screening.
Assuntos
Coccidioides/patogenicidade , Coccidioidomicose/transmissão , Transmissão de Doença Infecciosa , Transplante de Órgãos/efeitos adversos , Doadores de Tecidos , Comitês Consultivos , Coccidioidomicose/epidemiologia , Coccidioidomicose/etiologia , Seleção do Doador , Humanos , Segurança do Paciente , Prognóstico , Medição de Risco , Obtenção de Tecidos e Órgãos , Transplantados , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Coccidioidomycosis, a potentially fatal fungal infection, is considered an emergent mycotic disease because of the increased incidence of fungal infections registered over recent years. Infection occurs through the inhalation of arthroconidia from two main species of Coccidioides: Coccidioides immitis and C. posadasii, which are both endemic to arid and semi-arid regions of North America. Coccidioides species not only infect humans but can also infect other mammals (land, aquatic, wild or domestic), reptiles and birds. OBJECTIVE: To obtain information regarding the habitat of Coccidioides spp. and the animals infected by this fungus and to identify the role that infected animals play as reservoirs and disseminators of this fungus in nature. MATERIALS: A literature review was conducted to identify the habitat of Coccidioides spp. and the infected non-human animal species targeted by this fungus. RESULTS AND CONCLUSIONS: This review allows us to suggest that Coccidioides spp. may be classified as halotolerant organisms; nevertheless, to perpetuate their life cycle, these organisms depend on different animal species (reservoirs) that serve as a link with the environment, by acting as disseminators of the fungi in nature.
Assuntos
Coccidioides/fisiologia , Coccidioidomicose/transmissão , Reservatórios de Doenças , Vetores de Doenças , Ecossistema , Animais , Coccidioidomicose/microbiologia , Humanos , América do NorteRESUMO
Coccidioides spp. fungi, which are present in soil in the southwestern United States, can become airborne when the soil is disrupted, and humans who inhale the spores can become infected. In 2012, our institution in Maricopa County, Arizona, USA, began a building project requiring extensive excavation of soil. One year after construction began, we compared the acquisition of coccidioidomycosis in employees working adjacent to the construction site (campus A) with that of employees working 13 miles away (campus B). Initial testing indicated prior occult coccidioidal infection in 20 (11.4%) of 176 campus A employees and in 19 (13.6%) of 140 campus B employees (p = 0.55). At the 1-year follow-up, 3 (2.5%) of 120 employees from campus A and 8 (8.9%) of 90 from campus B had flow cytometric evidence of new coccidioidal infection (p = 0.04). The rate of coccidioidal acquisition differed significantly between campuses, but was not higher on the campus with construction.
Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/epidemiologia , Adulto , Idoso , Arizona/epidemiologia , Coccidioides/imunologia , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/transmissão , Indústria da Construção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Fatores de Risco , Microbiologia do Solo , Adulto JovemRESUMO
Coccidioidomycosis is a common, environmentally acquired, pulmonary fungal infection in arid and semi-arid regions of the West, especially Arizona and California. The infection is frequently associated with striking cutaneous manifestations. Reactive, immunologically mediated eruptions include erythema nodosum, a generalized exanthem, Sweet syndrome, and reactive granulomatous dermatitis. Less commonly, the skin can harbor the actual organisms as a result of dissemination from the lungs. Dermatologists may play a key role in the recognition of coccidioidomycosis
Assuntos
Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Biópsia , Coccidioides/classificação , Coccidioides/patogenicidade , Coccidioides/ultraestrutura , Coccidioidomicose/patologia , Coccidioidomicose/transmissão , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Dermatomicoses/patologia , Dermatomicoses/transmissão , Diagnóstico Diferencial , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/transmissão , Pele/patologiaRESUMO
Histoplasmosis is a systemic infection caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, primary pulmonary infection can spread to the skin and meninges. Clinical manifestations appear in patients with a CD4(+) lymphocyte count of less than 150 cells/µL. Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis and Coccidioides posadasii. It can present as diffuse pulmonary disease or as a disseminated form primarily affecting the central nervous system, the bones, and the skin. Cryptococcosis is caused by Cryptococcus neoformans (var. neoformans and var. grubii) and Cryptococcus gattii, which are members of the Cryptococcus species complex and have 5 serotypes: A, B, C, D, and AD. It is a common opportunistic infection in patients with human immunodeficiency virus (HIV)/AIDS, even those receiving antiretroviral therapy. Histopathologic examination and culture of samples from any suspicious lesions are essential for the correct diagnosis of systemic fungal infections in patients with HIV/AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Micoses/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Contagem de Linfócito CD4 , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Coccidioidomicose/epidemiologia , Coccidioidomicose/microbiologia , Coccidioidomicose/transmissão , Criptococose/diagnóstico , Criptococose/epidemiologia , Criptococose/microbiologia , Criptococose/transmissão , Cryptococcus gattii/isolamento & purificação , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/diagnóstico , Dermatomicoses/etiologia , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Diagnóstico Diferencial , Fungemia/diagnóstico , Fungemia/etiologia , Fungemia/microbiologia , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Histoplasmose/transmissão , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Micoses/etiologia , Micoses/microbiologia , Úlcera Cutânea/etiologia , Espanha/epidemiologiaRESUMO
Coccidioidomycosis in solid organ transplant recipients most often occurs as a result of primary infection or reactivation of latent infection. Herein, we report a series of cases of transplant-related transmission of coccidioidomycosis from a single donor from a non-endemic region whose organs were transplanted to 5 different recipients. In all, 3 of the 5 recipients developed evidence of Coccidioides infection, 2 of whom had disseminated disease. The degree of T-cell immunosuppression and timing of antifungal therapy initiation likely contributed to development of disease and disease severity in these recipients. This case series highlights the importance of having a high index of suspicion for Coccidioides infection in solid organ transplant recipients, even if the donor does not have known exposure, given the difficulties of obtaining a detailed and accurate travel history from next-of-kin.
Assuntos
Antifúngicos/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/transmissão , Fungemia/microbiologia , Transplante de Órgãos/efeitos adversos , Doadores de Tecidos , Adolescente , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Evolução Fatal , Feminino , Fluconazol/uso terapêutico , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Terapia de Imunossupressão/métodos , Masculino , Pessoa de Meia-Idade , Linfócitos T/imunologia , Coleta de Tecidos e Órgãos , Viagem , Adulto JovemRESUMO
We report disseminated coccidioidomycosis in 3 transplant recipients from a donor in an endemic area found to have unrecognized meningeal coccidioidomycosis. All 3 transplant recipients presented within 3 weeks of receipt of their organ. Only 1 organ recipient survived the acute presentation of coccidioidomycosis. Serologic testing for Coccidioides immitis infection should be considered for organ donors residing in endemic areas.
Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/transmissão , Fungemia/microbiologia , Transplante de Coração/efeitos adversos , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Adulto , Idoso , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Feminino , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Coleta de Tecidos e Órgãos , Transplantes/efeitos adversos , Adulto JovemRESUMO
Coccidioidomycosis is common in the southwestern United States, northern Mexico, and areas of South America. Coccidioides immitis and Coccidioides posadasii form arthroconidia that, if inhaled, can cause respiratory infection. Rarely, the organism disseminates throughout the body, causing disease in bones, lymph nodes, skin, joints, and brain in most severe cases. Certain populations are at higher risk for dissemination, including persons with compromised cellular immunity. This group includes patients with human immunodeficiency virus, patients undergoing immunosuppression for rheumatologic disorders, and patients receiving antirejection therapy after organ transplant. For patients undergoing a solid organ transplant in endemic areas, screening for past or present coccidioidal disease is completed pretransplantation. Those with known disease are given triazole therapy to prevent reactivation of disease posttransplantation. Usually, transplantation is postponed if the disease is active. We present a patient with known, active coccidioidomycosis who underwent successful liver transplant and later had subclinical posttransplantation peritoneal dissemination.
Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/transmissão , Fígado/microbiologia , Transplante , HIV , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 3-mo-old male llama was examined because of a 4-wk history of lethargy and ill thrift. Clinical examination revealed subcutaneous masses in the left prescapular and right inguinal regions, mild ataxia, a slight head tilt to the right, and right ear droop. The cria died before clinical workup was complete. At autopsy, there was generalized lymphadenomegaly, a hepatic nodule, a midbrain mass causing rostral compression of the cerebellum, and internal hydrocephalus. Microscopic findings included pyogranulomatous lymphadenitis, meningoencephalitis, hepatitis, and bronchopneumonia. Intralesional fungal spherules, most consistent with Coccidioides spp., were identified in the lymph nodes, lung, and brain. Fungal culture, single-nucleotide variation genotyping real-time PCR, and DNA sequencing confirmed Coccidioides posadasii. The dam of the cria was native to Arizona and had been moved to Missouri ~2.5 y previously. Agar gel immunodiffusion assay of the herd revealed that only the dam was positive for Coccidioides spp.; 6 herdmates were negative. Computed tomography of the dam revealed multiple nodules within the lungs and liver, which were presumed to be an active coccidioidomycosis infection. This case of systemic coccidioidomycosis in a llama native to Missouri was presumably acquired by vertical transmission from the dam.
Assuntos
Camelídeos Americanos , Coccidioides/isolamento & purificação , Coccidioidomicose/veterinária , Transmissão Vertical de Doenças Infecciosas/veterinária , Animais , Coccidioidomicose/diagnóstico , Coccidioidomicose/patologia , Coccidioidomicose/transmissão , Masculino , MissouriRESUMO
We report an unusual case of coccidioidomycosis in the arm of a veterinary assistant without pulmonary symptoms. The patient had been bitten on the hand by a cat which was later diagnosed with disseminated disease. The patient responded to fluconazole therapy and remained asymptomatic at 2 months after cessation of therapy.
Assuntos
Mordeduras e Picadas , Doenças do Gato/microbiologia , Doenças do Gato/transmissão , Coccidioidomicose/veterinária , Adulto , Animais , Antifúngicos/uso terapêutico , Gatos , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/transmissão , Feminino , Fluconazol/uso terapêutico , HumanosRESUMO
Historically, untreated disseminated coccidioidomycosis during pregnancy was thought to be associated with 100% maternal fatality and 50% fetal mortality and was the leading cause of maternal deaths in areas of endemicity. As recently as 1995, therapeutic abortions and early deliveries were advocated in certain contexts. This report describes an unrecognized case of disseminated coccidioidomycosis diagnosed at the time of placental examination in a woman who completed her pregnancy without significant maternofetal complications. This case suggests that abortion and early delivery may not be necessary, because the possibility of an uncomplicated pregnancy exists. It is likely that other similar cases exist but remain underreported or underdiagnosed because of the mild, nondescript nature of the illness and low clinical suspicion. Although this mother and infant had good clinical outcomes, thorough travel histories and consideration of the associated travel-related diseases are important because of the possibility of serious, potentially avoidable clinical consequences.
Assuntos
Coccidioidomicose/epidemiologia , Coccidioidomicose/transmissão , Placenta/microbiologia , Adulto , Coccidioidomicose/diagnóstico , Feminino , Humanos , Morbidade , Gravidez , Complicações Infecciosas na Gravidez/microbiologiaRESUMO
Coccidioidomycosis is a fungal infection caused by Coccidioides immitis or Coccidioides posadasii. These fungi are known to thrive in desert climate. Fungi produce infectious arthroconidia in soil, they are aerosolized in the air and when inhaled by humans, usually cause infections such as pneumonia. The first cases of coccidioidomycosis in Brazil were reported in 1978. Since then, there have been other reports mainly from desert regions of Northeastern Brazil. The present report describes three cases of coccidioidomycosis on male farmers from Serra Talhada county, Pernambuco State, who developed pneumonia and were subsequently diagnosed with pulmonary coccidioidomycosis. These three farmers were successfully treated with oral fluconazole. They reported having hunted armadillos in a rural and arid area of Pernambuco State. Armadillos are known to be carriers of Coccidioides. This is the first report of infection caused by Coccidioides in Pernambuco State, Brazil.
Assuntos
Coccidioidomicose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Idoso , Animais , Antifúngicos/uso terapêutico , Tatus/microbiologia , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/transmissão , Fluconazol/uso terapêutico , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/transmissão , MasculinoRESUMO
Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements.
Assuntos
Doenças Transmissíveis Importadas/epidemiologia , Emigração e Imigração , Doenças Endêmicas , Hospitalização , Micoses/epidemiologia , Micoses/transmissão , Adulto , Coccidioidomicose/epidemiologia , Coccidioidomicose/microbiologia , Coccidioidomicose/transmissão , Doenças Transmissíveis Importadas/microbiologia , Feminino , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Histoplasmose/transmissão , Humanos , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Micoses/microbiologia , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/transmissão , Estudos Retrospectivos , EspanhaRESUMO
An unusual, nonendemic case of fomite-transmitted, disseminated coccidioidomycosis in a neutropenic 3-year-old boy is presented. Accurate diagnosis of coccidioidomycosis hinges on recognition of host risk factors, clinical signs and symptoms, and effective implementation of diagnostic studies. Timely diagnosis and treatment is critical for improved morbidity and mortality in the pediatric oncology population.
Assuntos
Coccidioidomicose/transmissão , Fômites/microbiologia , Pré-Escolar , Humanos , MasculinoRESUMO
This first observation of donor-transmitted coccidioidomycosis in a pediatric liver-transplant recipient underlines a rare condition in transplanted patients in a nonendemic area. This transmission was observed after a liver split, the patient being contaminated by the left liver while the right-liver recipient was not.
Assuntos
Coccidioidomicose/transmissão , Transplante de Fígado/efeitos adversos , Transplantes/parasitologia , Criança , Feminino , HumanosAssuntos
Coccidioides/imunologia , Coccidioidomicose/diagnóstico , Coccidioidomicose/microbiologia , Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/microbiologia , Testes Sorológicos/métodos , Anticorpos Antifúngicos/sangue , Antígenos de Fungos/sangue , Biomarcadores/sangue , Coccidioides/patogenicidade , Coccidioidomicose/transmissão , Testes de Fixação de Complemento/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Técnica Indireta de Fluorescência para Anticorpo/métodos , Humanos , Paracoccidioidomicose/transmissão , Manejo de Espécimes/métodos , ViagemAssuntos
Coccidioidomicose/transmissão , Transplante de Pulmão/efeitos adversos , Transplantados , Coccidioidomicose/diagnóstico , Coccidioidomicose/patologia , Evolução Fatal , França , Humanos , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Peru , Radiografia Torácica , Doadores de Tecidos , Doença Relacionada a ViagensRESUMO
Most cases of coccidioidomycosis in organ transplant recipients arise from either primary infection with Coccidioides immitis after environmental exposure or from reactivation of latent infection. Herein, we report 2 cases of rapidly fatal, disseminated coccidioidomycosis that occurred in organ transplant recipients who had never lived in or visited an area where C. immitis is endemic. Both subjects had received a transplanted organ from the same donor, an individual with unrecognized active coccidioidomycosis at the time of his death.
Assuntos
Coccidioides , Coccidioidomicose/mortalidade , Transplante de Órgãos/efeitos adversos , Doadores de Tecidos , Adulto , Coccidioidomicose/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Coccidioidomycosis is accepted as being noncontagious because the infectious arthroconidial form of Coccidioides immitis is not produced in humans and other mammalian hosts. However, disseminated coccidioidomycosis developed in a veterinarian who autopsied a horse with disseminated disease but without draining lesions or productive cough. We postulate transmission occurred by inhalation of tissue-phase endospores aerosolized in the course of dissection.