Post on 24-Feb-2016
description
Coccidioidomycosis
Demosthenes Pappagianis, M.D., Ph.D.University of California, Davis
November 2011
Institution* Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Tota
l
Popu
latio
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Infe
ctio
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100,
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Pleasant Valley SP 18 6 8 13 6 18 33 44 62 71 41 37 357 4647 7682Avenal SP 5 3 3 4 7 10 9 41 49 52 27 6 216 5723 3774Cal SP, Corcoran 4 2 1 1 0 2 1 1 4 5 4 3 28 4876 574Cal Men's Colony, San Luis Obispo 1 0 2 1 0 2 0 0 4 6 5 2 23 6139 375Cal SP, Los Angeles Co, Lancaster 3 0 1 0 3 5 3 0 2 2 3 0 22 4356 505Kern Valley SP 0 3 1 1 1 0 1 4 3 4 1 0 19 4663 407Cal Corr Ctr, Susanville 0 0 0 1 0 0 0 1 3 1 1 0 7 5460 128Cal Corr Inst, Tehachapi 2 0 0 0 0 0 0 0 1 0 3 1 7 5519 127Cal SATF and SP, Corcoran 0 1 1 0 1 0 0 0 1 1 2 0 7 6082 115Corr Training Fac, Soledad 1 2 0 0 0 0 2 1 0 0 0 0 6 6538 92Mule Creek SP 2 0 0 0 0 2 0 1 0 0 0 1 6 3523 170Cal Rehab Ctr, Norco 0 0 0 2 0 0 1 0 0 0 1 0 4 4132 97RJ Donovan Corr Fac, San Diego 2 0 0 0 0 0 0 2 0 0 0 0 4 4369 92Sierra Conserv Ctr, Jamestown 0 0 0 0 0 0 1 1 0 2 0 0 4 5314 75Deuel Vocational Inst, Tracy 0 0 1 0 0 0 0 0 0 2 0 0 3 3785 79Cal Medical Fac, Vacaville 1 0 1 0 0 0 0 0 0 0 0 0 2 2737 73High Desert SP, Susanville 0 0 1 0 0 0 0 0 0 0 0 1 2 4128 48Cal Inst for Women, Corona 0 0 0 0 0 1 0 0 0 0 0 0 1 2071 48Cal SP, Calipatria 0 0 0 0 0 0 0 0 0 1 0 0 1 4153 24Cal SP, San Quentin 0 0 0 0 0 0 0 0 0 0 1 0 1 4983 20Cal SP, Solano 0 1 0 0 0 0 0 0 0 0 0 0 1 5022 20Chuckwalla Valley SP 0 0 0 0 0 0 0 0 1 0 0 0 1 3159 32Valley SP, Chowchilla 0 0 0 0 0 0 0 0 0 0 0 0 0 3296 0
Totals: 39 18 20 23 18 40 51 96 130 147 89 51 722 104675 14559
Coccidioidal Infections for 2010 in California State Prisons
0
0.5
1
1.5
2
0
20
40
60
80
INC
HE
S
RA
IN
NU
MB
ER
OF
CA
SE
SComparing Rainfall to Coccidioidal
Infections at Two Prisons
Coalinga Rainfall Pleasant Valley SP Avenal SP
New Coccidioidomycosis California Correctional Institutions (CCI)
January – September 2011(UC Davis Coccidioidomycosis Serology Lab)
CCI PVSP Avenal CA State
Month Monthly cases
Year total
Monthly cases
Year total
Monthly cases
Year total
Monthly cases
Year total
Jan 73 73 38 38 24 24 413 413
Feb 42 114 19 57 15 39 272 685
Mar 50 165 22 79 21 60 288 973
Apr 38 203 23 102 9 69 295 1268
May 38 241 21 123 13 82 308 1576
Jun 44 285 20 143 14 96 280 1856
Jul 39 324 16 159 16 112 366 2222
Aug 75 399 36 195 28 140 243 2465
Sep 97 496 39 234 45 185 139 2604
Domingo Escurra -First patient with
Coccidioidomycosis (1892)
Domingo Escurra
Joao SilveiraSecond case, recognized in
California(1894)
Coccidioidomycosis - California Endemic
Areas
Coalinga
Soledad
Paso RoblesAvenal
Calif. Men’s Colony
Dye Creek
Corcoran
OtayTecate
Archeology students - California
Transmission of Coccidioidomycosis Human to Human CASE
SOURCE
OUTCOME
REFERENCE
Mortician abraded skin of finger while embalming
Expired patient with disseminated coccidioidomycosis
Spread from finger to epitrochlear and axillary lymph nodes survived no therapy
Wilson et al., 1953
House staff (3), nurses (3) Patient with disseminated coccidioidomycosis of knee; organism grew on and dispersed from plaster of Paris cast dispersing arthroconidia
Survived; none disseminated Eckmann et al., 1964
Neonate Mother with coccidioidomycosis of endometrium and cervix
Mother survived, infant died Bernstein et al., 1981
Neonates (twins) Mother with disseminated disease, transplacental
Mother died, infants died Shafai, 1978
Neonate Mother with disseminated coccidioidomycosis of cervix of uterus infected amniotic fluid
Human with transplanted lung
Donor with pulmonary coccidioidomycosis Survived
Larwood, 1962
Tripathy et al., 2002
Human with transplanted kidney Human with transplanted liver
Donor with (unknown) prior disseminated coccy
Fatal
Fatal
Wright et al., 2003“ “
Human with transplanted lung
Donor with quiescent coccidioidomycosis of lungs
Fatal Miller et al., 2004
Infant died; mother survived 5 years
Female with pelvic/ abdominal coccy Husband’s semen – artificial
inseminationLiving
H. Chope1929
Coccidioidal Erythema Nodosum
( Pappagianis 1998)
Night sweats,Anorexia
Coccidioidomycosis - Spectrum of Disease
Woman with Chronic Coccidioidal Cavity – Right Lung
Mannose binding lectin?
Time to Dissemination
Sites involved in disseminated coccidioidomycosis
Fatal, autopsied series Survivors ___________________________________________________________________________________ Forbus and Huntington, Sievers Total Sievers Bestebreurtje et al. (1946) (1967) (1974) (1974) Number of Patients: 50 131 20 201 16 % % % % % Lung 86 86 60 84 25 Spleen 70 51 25 53 0 Liver 60 45 35 48 0 Kidney 60 35 48 41 0 Skin &Subcut. 64 21 0 29 31 Bone 48 16 22 22 13 Leptomeninges 36 *63 **55 55 13 Adrenal 32 17 20 21 0 Heart (pericardium), pancreas, psoas and retroperitoneal, thyroid, prostate, larynx, scrotum, optic nerve, bladder, penis, placenta, parotid gland, tongue, mastoid bone, periosteum of orbit. ______________
*36 or 27% with solitary meningitis
Coccidioidal Basilar Meningitis
H. Einstein
CSF compartments
?
,(-) skin tests