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Primary Endemic Mycoses

Treatment

1. Agents of Choice

2. Treat

Primary Endemic Mycoses histoplasma, coccidioides

· Observe (?)

· Asymptomatic acute lung disease in normal host

Blastomycosis Pearls

3. Beaver ponds

· Pneumonia with purulent sputum, unresponsive to ATB in endemic areas

· Pyogranulomatous inflammation; broad based, double contoured yeast

· Osteomyelitis in fiat bones

· Serology, skin test - poor

· Diff DX Histo, TBC histoplasma, coccidioides

Coccidioidomycosis

· Coccidioides immitis

· Non thermal dimorphic (C02)

· Mold form grows in soil, mycoses, histoplasma, coccidioides arthroconidia infective

· Inhaled arthrocondia _ septate spherules (10-200 µm)

containing endospores

· Endospores spherules to complete life cycle

· Growth, release of endospores f with progest, estradiol, testosterone

Epidemiology

· Southwestern U.S., northern Mexico

· Desert soil, aerosolization, inhalation

· Acquired recreationally, occupationally

· 25-100,000 cases in U.S./year

summer/early fall

· 77% skin test positive children living in endemic area > 10 years

Clinical Features of C. Immitis Infection

· Asymptomatic infection 60%

·Pulmonary