Pulmonology Book

http://www.fpnotebook.com/

CoccidioidomycosisAka: Coccidiomycosis, Coccidioides immitis

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  1. Epidemiology
    1. Important opportunistic infection in southwestern US
  2. Pathophysiology
    1. Infection with fungus Coccidioides immitis
  3. Symptoms
    1. Chills, weight loss
    2. Productive cough
    3. Chest Pain
    4. Arthralgias
  4. Signs
    1. Fever
    2. Cervical adenopathy
    3. Skin lesions
      1. Resemble Erythema Nodosum
    4. Lung
      1. Pleural Effusion
      2. Friction rub
      3. Pulmonary rales
  5. Lab
    1. Sputum KOH
      1. Positive for fungal elements
    2. Blood complement-fixing antibodies
      1. Positive
  6. Diagnosis
    1. Coccidioidomycosis serology: IgM
      1. IgM positive by third week in 90% of patients
      2. Becomes negative 3 months after infection
    2. Complement fixation of IgG
      1. Low sensitivity, but high Specificity
    3. Skin Testing (for epidemiologic studies)
      1. Coccidioidin skin test
      2. Spherulin skin test
  7. Differential Diagnosis in HIV patients
    1. PCP Pneumonia
  8. Affected Organs
    1. Lung most commonly affected (similar to Pneumocystis)
  9. Management
    1. Disseminated disease
      1. Amphotericin B
    2. Palliative Therapy
      1. Fluconazole 600-800 mg/day
      2. Itraconazole 400 mg/day

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