Understanding Coccidioidomycosis: Causes, Symptoms, and Treatment.

Coccidioidomycosis, commonly known as Valley Fever, is a fungal infection caused by the inhalation of spores from the fungi Coccidioides immitis or Coccidioides posadasii. These fungi are found in soil, particularly in arid regions of the southwestern United States, parts of Mexico, and Central and South America. The infection primarily affects the lungs, leading to flu-like symptoms such as cough, fever, chest pain, and fatigue. In some cases, the infection can spread to other parts of the body, leading to more severe complications. Valley Fever is typically diagnosed through blood tests, imaging, or tissue samples, and treatment may involve antifungal medications, especially in severe or disseminated cases.

1. Coccidioidomycosis S.NAHIDHA BEGUM I –M.Sc Microbiology Department of Microbiology Sacred Heart College

2. Coccidioidomycosis is a systemic infection caused by inhalation of  Coccidioides immitis  or  Coccidioides posadasii  spores . It affects both humans and animals. It is also known as  Valley fever or cocci or California fever, or desert rheumatism, or San Joaquin Valley fever. The spores of the causative agents are commonly found in soil in endemic areas, where they get distributed into the air. It commonly occurs in gardening areas, construction, farming, wind areas. Endemic areas affected are the arid areas of the United States in Arizona, California, Nevada, New Mexico, Texas, Utah, and Northern Mexico. Coccidioidomycosis Coccidioides immitis

3. MORPHOLOGY thin, septate, hyaline or glass-like hyphae, from which numerous, thick- walled Arthroconidia/ endospore The average arthrospore measures 3.0 x 4.5µm, and is barrel-shaped. Grow- sandy, alkaline soil, extreme temperatures and high salinity

4. TRANSMISSION Humans, animals = accidental hosts Routes of transmission Inhalation Inoculation (penetrating objects) Dust-covered fomites Communicability Direct transmission between people or animals very rare

5. LIFE CYCLE At the time of asexual reproduction, multiple sac of arthoconidia produced, due to fragmentation of single sac separated. From that spherule produced , it divided into several segments, it forms endospores and release of endopores

6. Risk factors of Coccidioidomycosis infection People that are living or traveling into endemic areas where the  Coccidioides  fungus occurs are at risk of infection. Dust storms carrying the fungal spores of contaminated soil such as farms or construction sites increases the risks of exposure and infection. People who have compromised immune systems are at increased risk of developing the severe or disseminated disease. These include: HIV/AIDS patients Autoimmune patients and rheumatoid disease patients taking immune-suppressing drugs Organ transplant recipients Diabetic patients Pregnant women Pathogenesis of Coccidioidomycosis

7. Clinical manifestation Primary Pulmonary Coccidioidomycosis Progressive Pulmonary Coccidioidomycosis Disseminated Coccidioidomycosis Coccidioidal Meningitis

8. Some of the major clinical manifestations of coccidioidomycosis include: Acute and chronic inflammation which is associated with the production of neutrophils and eosinophils in response to endospore exposure in the alveolar sacs and the lung tissues. Neutrophils and eosinophils get attracted to the site where the spherules rupture and release endospores. Chronic granulomatous infection occurs when mature spherules do not rupture, which is an indication of Coccidiodes’ control. progressive Pulmonary coccidioidomycosis which is normally chronic with multiplication and enlargement of nodules or/and cavities. clinical manifestations

9. Disseminated coccidioidomycosis which is debilitating and life-threatening; commonly affecting men than women except for pregnant women. Men most affected are those the elderly, those with underlying conditions, HIV/AIDS patients. Majorly caused by  C. immitis  which has estrogen-binding proteins, and elevated levels of estradiol and progesterone stimulate its growth. Coccidioides Meningitis which is a disseminated infection commonly affecting the Central Nervous system and brain of AIDS patients

10. Symptoms Initial often with mild fever Flu Cough Chills Chest pain Night sweat Muscle/joint ache Rash

11. Diagnosis Diagnosis of Coccidioidomycosis Specimen : Sputum, pleural fluid, Cerebrospinal fluid, lesion exudates, biopsy Microscopic examination Use of KOH Wet mount and calcofluor stains are used for observation of spherules which is usually 20 to 80 micrometers in diameter, thick-walled, and small endospores of 2 to 4 um for  C. immitis. Cultural –white or buff , variable texture

12. Serological Testing Testing for anti-coccidiodidal antibodies, IgG and IgM for confirmation Immunodiffusion for detection of IgM and IgG antibodies against coccidioidomycosis Complement Fixation  ELISA Chest xray CT / MRI Scan PCR is used to test for fungal DNA from samples from the lower respiratory tract.

13. Treatment of Coccidioidomycosis Mild to moderate disease can be treated with fluconazole or itraconazole Severe disease is treated with Amphotericin B HIV/AIDS patients with coccidioidomycosis associated infections use maintained therapy of fluconazole or itraconazole while monitoring the CD4 cell count at about > 250/mcL. Ketanazole OPTIONS Antifungal drugs surgical excision / debridement

14. Prevention and Control of Coccidioidomycosis Difficult to prevent in endemic areas Dust control Prophylactic drug treatment No vaccine available Clean and disinfect. Some measure of control can be achieved by reducing dust, paving roads and airfields, planting grass or crops, and using oil sprays.

15. REFERENCES : Medical Microbiology by Jawertz 25th Edition. https://www.msdmanuals.com/professional/infectious-diseases/fungi/coccidioidomycosis https://www.ncbi.nlm.nih.gov/books/NBK448161/ https://my.clevelandclinic.org/health/diseases/17754-valley-fever-coccidioidomycosis https://dermnetnz.org/topics/coccidioidomycosis/ Medical microbiology by S.Rajan https://microbenotes.com/coccidioidomycosis/

16. THANK YOU