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Coccidioidomycosis:
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Fungal weapon active against humans |
Synopsis, Diagnosis, Symptoms,
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Safety Precautions for Casualties |
Standard Precautions defined by the 1996 CDC guidelines should be adopted for handling patients. Contact precautions may be needed for patients with draining lesions.Biosafety level 3 practices should be adopted for handling of samples. |
| Causative organism: (Systematic name in 1997) | Coccidioides immitis |
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| Classification: | An arthrospore-forming filamentous fungus belonging the mitosporic or imperfect fungi (fungi with no known sexual stage). |
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The commonest symptoms are a dry cough, chest pain, headache, a dry rash that may develop into tender red nodules on the lower legs.
Differential DiagnosisOther disease or conditions that need to be eliminated |
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| Other infectious diseases | Other problems |
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Symptoms and effects. The disease is often mild and clears after a few weeks. After an incubation period of about a month dry cough, pleuritic chest pain, dypsnea (difficulty breathing), malaise, headache and a rash. In some case, especially Caucasian women, tender red nodules develop on the shins with joint pain in the knees and shins. A fever that lasts for several weeks is often the only symptom.
In more serious cases, the fungus disseminates through the body causing fever and abscesses. When the lungs are affected, tuberculosis-like lesions are developed and the patient will cough up blood.
Mortality is about 60% for sufferers of the disseminated form of the disease.
Medical and Physical Countermeasures.
Vaccination (Immunoprophylaxis)
A vaccine is not available.
Specific Therapy
Antimycotics (amphotericin B, fluconazole and itoconazole) may be used. In severe cases intravenous administration may be necessary. In cases of coccidioidal meningitis, the drug may have to be administered directly into the spinal cord via a lumbar puncture.
Miconazole and ketoconazole suppress growth of the organism but do not kill it.
Supportive care
The fungus is killed by 1% sodium hypochlorite, phenolics, glutaraldehyde, and formaldehyde.
Agent Properties and Potential Uses
Spores of the fungus are hardy and can survive in dry soil for many years. They are easily spread as aerosols and by coughing. When inhaled, the spores grow into small speherules that fill with spores and then burst.
The disease is found in arid regions of the southwestern United States and is a common risk for agricultural workers. It is also a risk for immunocompromised patients who will need to take antimycotics for the rest of their lives if infected. Outbreaks often occur after earthquakes when spores resting in soil are thrown into the air by the violent ground movements.
Terrorist Acquisition and Attempted Use.
| Disease | ICD-9-CM | ICD-10 |
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| Coccidioidomycosis | 114 | B38 |
| Acute pulmonary coccidioidomycosis | B38.0 | |
| Chronic pulmonary coccidioidomycosis | B38.1 | |
| Primary coccidioidomycosis (pulmonary) | 114.0 | B38.2 |
| Coccidiomycosis of the skin | B38.3 | |
| Primary extrapulmonary coccidioidomycosis | 114.1 | |
| Coccidioidal meningitis | 114.2 | B38.4 |
| Disseminated coccidiomycosis | B38.7 | |
| Other forms of progressive coccidioidomycosis | 114.3 | B38.8 |
| Coccidioidomycosis, unspecified | 114.9 | B38.9 |
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