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2010, Number 5

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Med Cutan Iber Lat Am 2010; 38 (5)

Coccidioidomicosis

Negroni R, Arechavala A, Maiolo E

Language: Spanish
References: 23
Page: 179-188
PDF size: 256.00 Kb.


ABSTRACT

Coccidioidomycosis is a systemic mycosis endemic in America, produced by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. The first species is responsible for the infections in California and the second one produces coccidioidomycosis of the other endemic areas. These microorganisms live in soil of arid regions and they are able to infect human beings and other animals by inhalation of arthroconidiae. The majority of the infections are mild and self-limited due to the high efficacy of cell mediated immunity. When the immunity response is not effective, progressive coccidioidomycosis shows a wide spectrum of clinical manifestations from chronic pneumonia to acute life threatening disseminated forms. In last decades the incidence of severe disseminated coccidioidomycosis in patients with different risk factors has increased, the main associated predisposing factors are AIDS, lymphomas, diabetes, treatments with high doses of corticosteroids or other immunosuppressive drugs and organs transplantations. The diagnosis in made by finding spherules of Coccidioides in direct microscopic examination and/or the isolation of these fungi in cultures of different clinical samples, by mean of mycological or histopathological studies. Serologic tests searching for antibodies are very efficient diagnostic tools, immunodiffusion in agar gel and complement fixation test are the reactions most often used. Amphotericin B desoxycholate and its lipid formulations as well as the azolic compounds, such as fluconazole, itraconazole and second generation triazoles voriconazole and posaconazole have shown to be active against Coccidioides. Amphotericin B is usually indicated in severe cases and azoles in chronic case, fluconazole in high doses has shown to be very effective in chronic meningitis. There is not any active vaccine for the prevention of this mycosis.


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