Moroyoqui LA, Figueroa SSR

Language: Spanish
References: 0
Page: 125-141
PDF size: 361.64 Kb.

ABSTRACT

Coccidioidomycosis is a millenarian disease that has accompanied the humanity from the ancestral times, limited practically to the American continent. It is caused by a dimorphic fungus Coccidioides with two species identified: immitis and posadasii, with equal genotypical but phenotypical difference, but apparently no clinical or therapeutic significance. There are not reliable statistic of coccidioidomycosis in Mexico. Due to lack of legislation on the matter is not obligatory to report, it does not seem to be a public health problem, but this can only be demonstrated when reliable statistics are available. More than half of the primary infections are asymptomatic; the rest present with signs and general, dermatological and respiratory symptoms. The disease is also known as valley fever or desert rheumatism. The acute pulmonary presentation is indistinguishable from bacterial community acquired pneumonia. Extrapulmonary coccidioidomicosis is seem in 0.5% of the cases; the most commonly involved are the meninges, bones, joints, skin and soft tissues. The diagnosis is based mainly on the identification and isolation of the saprophytic or parasitic fungus by means of culture and genetic soundings or microscopic visualization of the fungus in any of two phases in fluids or tissues. At present in our country we have a variety of serology tests. Clinical presentation ranges from a noncomplicated autolimited first infection without treatment, to the acute disseminated forms almost always fatal despite treatment. For this reason therapeutic strategies vary considerably in different patients. For decades the most used antifungal drugs have been amfotericin B, fluconazole and itraconazole, currently new triazoles and echinocandins, as a monotherapy or combined, promise to be a new alternative in the treatment of chronic or disseminated coccidioidomycosis a therapeutic challenge.