Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

Abstract INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

Derrame pleural por micosis endémica en un paciente de 8 años: reporte de un caso / Pleural effusion due to endemic mycosis in an 8-year-old patient: a case report

Coccidioides is a fungus that is frequently found in dry places of sparse storms, with warm temperatures during most of the year. Two species are known to infect the human being: C. immitis and C. posadasii.It is endemic in northern Mexico, southern United States, as well as in some regions of Central America and South America. It is a highly contagious organism, but mostly it generates self-limited and asymptomatic diseases. Only 10 percent of cases with pulmonary symptoms are severe and may manifest as lobar pneumonia. Some cases of multiple foci and pleural effusion are diagnosed through biopsy with molecular methods. The treatment in many cases includes the use of azole antifungals for 3-6 months and follow-up with antibody titres

El Coccidioides es un hongo que se encuentra de manera frecuente en lugares secos, con temperaturas cálidas durante la mayoría del año. Son dos especies las que se conoce que infectan al ser humano la C. Immitis y C. Posadasii. Es endémico del norte de México, sur de Estados Unidos, así como algunas pequeñas regiones de centro y Sudamérica. Es un organismo altamente contagioso, pero en su mayoría genera enfermedades autolimitadas y de tipo asintomático, los pacientes con manifestaciones pulmonares solamenteen 10 por ciento son de presentación grave. Esta puede ser como una neumonía lobar, pero en algunos casos de focos múltiples y con derrame pleural, el diagnóstico es mediante biopsia en a fechas recientes con métodos moleculares. Los tratamientos en muchos casos requieren únicamente vigilancia. De requerir tratamiento se usa antimicótico 3-6 meses con azoles y seguimientos con títulos de anticuerpos