Coccidioidomycosis

Brijesh Singh Yadavbrijeshbioinfo@gmail.comDisease Name

: Coccidioidomycosis

Common Name:

San Joaquin Valley fever, California valley fever, desert fever,

Disease Category:

Fungal Disease

Disease Description:

Coccidioidomycosis is the infection caused by the dimorphic fungus

Coccidioidesimmitis

. The disease is endemic only in regions of the Western Hemisphere. In the UnitedStates, the endemic areas include southern Arizona, central California, Southern NewMexico, and west Texas. The endemic region extends southward into Central and SouthAmerica. An arid climate, alkaline soils, hot summers, few freezings, and yearly rainfallsranging between 5 to 20 inches characterize this area. Outbreaks occur following duststorms, earthquakes, and earth excavation where dispersion for arthroconidia is favored.Coccidioidomycosis is acquired from inhalation of the spores (arthroconidia). Once in thelungs, the arthroconidia transform into spherical cells called "spherules". An acuterespiratory infection occurs 7 to 21 days after exposure and typically resolves rapidly.However, the infection may alternatively result in a chronic pulmonary condition or disseminate to the meninges, bones, joints, and subcutaneous and cutaneous tissues.About 25% of the patients with disseminated disease have meningitis . The face of Biologicalwarfare Chronic cutaneous Leg infectionFig.1.Showing different from of coccidiomycosis

Types of the disease:Asymptomatic:

Occurs in about 50% of patients

Acute Symptomatic:

Pulmonary syndrome that combines cough, chest pain,shortness of breath, fever, and fatigue.Diffuse pneumonia affects immunosuppressed individualsSkin manifestations include fine papular rash, erythema nodosum, andErythema multiforme Occasional migratory arthralgias and fever

Chronic Pulmonary:

Affects between 5 to 10% of infected individuals

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Usually presents as pulmonary nodules or peripheral thin-walled cavities

Extrapulmonary/Disseminated Varieties:Chronic skin disease

:Keratotic and verrucose ulcers or subcutaneous fluctuant Abscesses

Joints / Bones:

Severe synovitis and effusion that may affect knees, wrists, feet, ankles,And/or pelvisLytic lesions commonly affecting the axial skeleton

Meningeal Disease:

The most feared complicationPresenting with classic meningeal symptoms and signsHydrocephalus is a frequent complication

Others:

May affect virtually any organ, including thyroid, GI tract, adrenal glands,genitourinary tract, pericardium, peritoneum

Host organism:

It has been known to infect humans, dogs, cattle, livestock, llamas, apes,monkeys, kangaroos, wallabies, tigers, bears, badgers, otters and marine mammals.

Causal Organism:

Coccidioides immitis/posadasii

Pathogen Description:

Coccidioides immitis

and

C. posadasii

are thermally dimorphicfungi found in soil particularly at warm and dry areas with low rain fall, high summer temperatures, and low altitude. The two species are morphologically identical butgenetically and epidemiologically distinct.

C. immitis

is geographically limited toCalifornia's San Joaquin valley region, whereas

C. posadasii

is found in the desertsouthwest of the United States, Mexico, and South America. The two species appear toco-exist in the desert southwest and Mexico.Although it was recognized for some years that

C. immitis

contained two geneticsubgroups, their description as separate species did not occur until 2002 . Prior to this, thetwo groups were simply known as the California and non-California variants of

C.immitis

. Thus, essentially all prior literature treats them as a single species. As the twospecies can be distinguished only by genetic analysis and different rates of growth in the presence of high salt concentrations (

C. posadasii

grows more slowly), little is known asyet about differences in pathogenicity. Thus, the remainder of this discussion will simplyrefer to the pair of species as

C. immitis/posadasii

specifically inhabits alkaline soil. It is isolated in rodent burrows atdesert-like areas of southwest United States. It has no known teleomorph.

Coccidioides immitis/posadasii

is a pathogenic fungus and is among the causative agentsof true systemic (endemic) mycoses. It is endemic at southwest United States, NorthernMexico, and certain areas in Central and South America. Imported cases may beobserved following travel to endemic areas.

Taxonomic Classification:

Coccidioides immitis/posadasii

Other Species:

Coccidioides immitis

and

C. posadasii

are the only species included in the genus

Coccidioides.

Macroscopic Features:

Coccidioides immitis/posadasii

colonies grow rapidly. The macroscopic morphology may be very variable. At 25 or 37°C and on Sabouraud dextrose agar, the colonies are moist,glabrous, membranous, and grayish initially, later producing white and cottony aerialmycelium. With age, colonies become tan to brown in color.

Microscopic Features:

Microscopic appearance of the fungus depends on the temperature of isolation.

1. At 25°C

Hyphae and arthroconidia are produced. Hyphae are hyaline, septate and thin. Racquethyphae may occasionally be observed on slides prepared from young cultures.Arthroconidia are thick-walled, barrel-shaped, and 2-4 x 3-6 µm in size.Typically thesearthroconidia alternate with empty disjuncture cells. On the released arthroconidia,annular frills that are the remnants of the disjuncture cells are observed.

2. At 37°C

Large, round, thick-walled spherules (10-80 µm in diameter) filled with endospores (2-5

Kingdom: FungiPhylum: AscomycotaClass: EuascomycetesOrder: OnygenalesFamily: OnygenaceaeGenus: