zoonoses and communicable diseases common to ... - PAHO/WHO

322 MYCOSESthe primary respiratory disease does have sequelae, these consist of fibrotic or cavernouslesions in the lungs. Pneumonia may persist in some patients for six to eightweeks, accompanied by fever, chest pain, cough, or postration (persistent coccidioidalpneumonia). Mortality in these cases is high in immunocompromisedpatients. Another disease form is the chronic form, which can be confused withtuberculosis (Drutz, 1982).Extrapulmonary dissemination generally occurs following the primary disease inapproximately 0.5% of infections (CDC, 1993). Thoracic radiography may or maynot show abnormalities. The most common localization is in the cutaneous and subcutaneoustissues. Cutaneous lesions generally consist of verruciform granulomas(usually on the face), erythromatous plaques, and nodules. Sometimes there are subcutaneousabscesses. Osteomyelitis occurs in 10% to 50% of disseminated cases andmay affect one or more bones. Meningitis cases are frequent (33% to 50% ofpatients) and generally fatal within two years. Eosinophilic pleocytosis is frequentin coccidioidal meningitis and has diagnostic value (Ragland et al., 1993). Othermanifestations are thyroiditis, tenosynovitis, and prostatis (Drutz, 1982). Clinicalcoccidioidomycosis is more frequent among migrant workers and soldiers transferredto endemic zones. In endemic areas of C. immitis the symptomatic form ofthe disease is frequent in individuals infected by the human immunodeficiencyvirus. Immunodeficiency is an important risk factor for developing the disease(Ampel et al., 1993).Treatment is difficult and often unpredictable. Fungicides that were effective insome cases were not in other similar cases. It is estimated that less than 5% of thoseinfected need treatment. Those who are suffering from a progressive illness, patientswith severe primary pulmonary disease, and those who have disseminated infectionshould be treated. Treatment should also be considered for patients with a compromisedimmune system. Amphotericin B and ketoconazole are the medications mostfrequently used (Ampel et al., 1989). The administration of 400 mg of fluconazoledaily for up to four years to 47 patients with coccidioidal meningitis produced afavorable result in 37 patients (Galgiani et al., 1993).The Disease in Animals: The infection is asymptomatic in cattle. Lesions aregenerally limited to the bronchial and mediastinal lymph nodes. On rare occasions,small granulomatous lesions are found in the lungs and the submaxillary andretropharyngeal lymph nodes. Macroscopic lesions resemble those seen in cases oftuberculosis.Ziemer et al. (1992) conducted a retrospective study of 15 cases of coccidioidomycosisin horses recorded from 1975 to 1984 in a university hospital inCalifornia, with diagnosis confirmed by culture or histopathology. The most commonsymptom in 53% of the horses was chronic weight loss, which ranged from45.5 kg to 91 kg in three horses. One of the horses lost 24% of its body weight inthree months. Thirty-three percent of the horses had a persistent cough. Sixty percentof the animals had respiratory abnormalities detected through auscultation.Other symptoms were depression and superficial abscesses.Various cases have been described in sheep, with lesions similar to those in cattle.In the same university hospital in California, 19 cases of coccidioidomycosis wererecorded in llamas (10 from Arizona and 9 from California). Eighteen of the animalshad disseminated mycosis, with pyogranulomas in the lungs, thoracic ganglia, liver,