Primary Endemic Mycoses

Treatment

1. Agents of Choice

a. Amphotericin B induction for severe in infection

b. Itraconazole for mild illness and maintenance

2. Treat

a. All symptomatic patients

b. Extrapulmonary disease

c. Immunocompromised host (prophylax AIDS patients)

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

· Acute pulmonary infection resembles influenza

· Hypersensitivity manifestations (good sign)