Disseminated coccidioidomycosis in immunocompetent patients in non-endemic areas: a case series and literature review. 2022

Xiaoxiao Guo, and Qiaoling Ruan, and Jialin Jin, and Jianming Zheng, and Lingyun Shao, and Ning Li, and Liping Zhu, and Wenhong Zhang, and Yuekai Hu, and Mingquan Chen
Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Coccidioidomycosis is caused by the dimorphic fungi Coccidioides species which is endemic in the Western hemisphere. Reports on the characteristics of travel-related disseminated coccidioidomycosis in immunocompetent patients are rare, especially in non-endemic regions. The multifaceted symptoms of this condition present a diagnostic challenge to clinicians. This study aimed to review immunocompetent patients diagnosed with disseminated coccidioidomycosis in a tertiary hospital in Eastern China and other non-endemic areas, and to emphasize the importance of combining travel history with clinical manifestations and proper diagnostic examinations. This study retrospectively reviewed a case series of disseminated coccidioidomycosis diagnosed in an academic hospital in Eastern China. We conducted a global literature review of disseminated coccidioidomycosis in immunocompetent patients with travel history. We identified six patients in our case series and reviewed 42 cases in the literature. Travel history included Mexico, Arizona, California, and regions of low endemicity. Extrapulmonary sites of infection, which presented with diverse signs and symptoms, involved the skin and soft tissue, musculoskeletal system, lymph nodes, and central nervous system. Misdiagnoses and diagnostic delays were common. Next-generation sequencing substantially promoted precise diagnosis in our series. The overall prognosis for immunocompetent individuals was positive, mainly benefited from long-term azole therapies. The patients that succumbed had either central nervous system involvement or multiorgan dissemination. Progressive pneumonia with varied symptoms and travel history should alert healthcare professionals in non-endemic areas to consider the possibility of Coccidioides species infection. We recommend detailed history-taking and hypothesis-free detection of pathogens for cases with diagnostic delay.

UI MeSH Term Description Entries
D003045 Coccidioides A mitosporic fungal genus which causes COCCIDIOIDOMYCOSIS. Coccidioides immitis
D003047 Coccidioidomycosis Infection with a fungus of the genus COCCIDIOIDES, endemic to the SOUTHWESTERN UNITED STATES. It is sometimes called valley fever but should not be confused with RIFT VALLEY FEVER. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, a form of FUNGAL SPORES. A primary form is an acute, benign, self-limited respiratory infection. A secondary form is a virulent, severe, chronic, progressive granulomatous disease with systemic involvement. It can be detected by use of COCCIDIOIDIN. Coccidioides Infection,Coccidioides posadasii Infection,Coccidioidomycosis Infection,Coccidioides immitis Infection,San Joaquin Valley Fever,Valley Fever,Coccidioides Infections,Coccidioides immitis Infections,Coccidioides posadasii Infections,Coccidioidomycoses,Coccidioidomycosis Infections,Infection, Coccidioides,Infection, Coccidioides immitis,Infection, Coccidioides posadasii,Infection, Coccidioidomycosis,Valley Fevers
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000076082 Travel-Related Illness Health problems associated with TRAVEL. Travel Sickness,Travel-Associated Infections,Travel-Associated Infectious Diseases,Travel-Related Disease,Travel-Related Health Problems,Travel-Related Infections,Travel-Related Infectious Diseases,Travel-Related Sickness,Disease, Travel-Associated Infectious,Disease, Travel-Related,Disease, Travel-Related Infectious,Diseases, Travel-Associated Infectious,Diseases, Travel-Related,Diseases, Travel-Related Infectious,Health Problem, Travel-Related,Health Problems, Travel-Related,Illness, Travel-Related,Illnesses, Travel-Related,Infection, Travel-Associated,Infection, Travel-Related,Infections, Travel-Associated,Infections, Travel-Related,Infectious Disease, Travel-Associated,Infectious Disease, Travel-Related,Infectious Diseases, Travel-Associated,Infectious Diseases, Travel-Related,Problem, Travel-Related Health,Problems, Travel-Related Health,Sickness, Travel,Sickness, Travel-Related,Sicknesses, Travel,Sicknesses, Travel-Related,Travel Associated Infections,Travel Associated Infectious Diseases,Travel Related Disease,Travel Related Health Problems,Travel Related Illness,Travel Related Infections,Travel Related Infectious Diseases,Travel Related Sickness,Travel Sicknesses,Travel-Associated Infection,Travel-Associated Infectious Disease,Travel-Related Diseases,Travel-Related Health Problem,Travel-Related Illnesses,Travel-Related Infection,Travel-Related Infectious Disease,Travel-Related Sicknesses
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014195 Travel MOVEMENT across different GEOGRAPHIC LOCATIONS. Land Travel,Sea Travel,Land Travels,Sea Travels,Travel, Land,Travel, Sea,Travels,Travels, Land,Travels, Sea
D057210 Delayed Diagnosis Non-optimal interval of time between onset of symptoms, identification, and initiation of treatment. Diagnosis Delay,Late Diagnosis,Delayed Diagnoses,Diagnosis Delays,Diagnosis, Delayed,Diagnosis, Late,Late Diagnoses

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