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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneal coccidioidomycosis is extremely rare. This report describes a patient infected with the human immunodeficiency virus who presented with unexplained ascites and was found to have peritoneal coccidioidomycosis. The ascites had a low serum-ascites albumin gradient, and laparoscopy showed peritoneal implants that grew Coccidioides immitis. This case is unique in several ways; this is the first case in which a patient's acquired immunodeficiency syndrome-defining illness was peritoneal coccidioidomycosis, and the serum-ascites albumin gradient determination as well as laparoscopy provided information critical to the diagnosis. This patient's dramatic response to systemic antifungal therapy, as evidenced by resolution of ascites and constitutional symptoms, underscores the importance of timely diagnosis and prompt therapy. In summary, this report reviews the previous cases of coccidioidal peritonitis and reports the first case in which localized peritoneal coccidioidomycosis was the acquired immunodeficiency syndrome-defining illness in a human immunodeficiency virus-infected patient.
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PMID:Peritoneal coccidioidomycosis associated with human immunodeficiency virus infection. 153 43

Coccidioidomycosis occurs in greater than 50,000 persons each year. As concurrent infections with the human immunodeficiency virus become more frequent, the spectrum of coccidioidal illness has shifted toward more extensive and life-threatening disease. This trend has intensified interest in developing more-sensitive methods for diagnosis of coccidioidal infection early in its course. ELISA procedures that detect fungal antigen and antibodies in patient sera have been devised but require more-purified antigens for clinically useful specificity. Clinical trials of new drugs have been initiated that may offer advantages in safety, efficacy, or ease of administration. Itraconazole and fluconazole show promise, especially in the treatment of coccidioidal meningitis. However, it has not yet been determined whether either antifungal agent is more effective than established agents, such as amphotericin B or ketoconazole. These changes in the clinical spectrum, methods of diagnosis, and therapeutic options will likely influence the medical approach to coccidioidal infections in coming years.
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PMID:Coccidioidomycosis: changes in clinical expression, serological diagnosis, and therapeutic options. 156 79

A 33-kDa protein antigen purified from spherules of Coccidioides immitis was analyzed for ultrastructural localization and for binding to serum antibodies from infected or immunized humans. By using colloidal gold detection of affinity-purified anti-33-kDa protein antibodies, electron photomicrographs showed binding to the inner cell wall of arthroconidia and spherules and to the septa and glycocalyx surrounding endospores. Enzyme immunoassay measurements also demonstrated that the antigen was most abundant in mature spherules. Of 37 patients with coccidioidomycosis but without concurrent human immunodeficiency virus infections, all but 2 demonstrated immunoglobulin M (IgM) (usually with early infection) or IgG antibodies for the 33-kDa antigen. In contrast, only one of four HIV-infected patients with active coccidioidal infections demonstrated antibody. On the other hand, 107 of 108 patients without evident coccidioidomycosis and 15 of 16 patients with histoplasmosis did not have similar antibodies, indicating a high degree of specificity. Immunization of humans with a spherule vaccine produced IgM responses to this antigen that were not evident in placebo recipients.
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PMID:An arthroconidial-spherule antigen of Coccidioides immitis: differential expression during in vitro fungal development and evidence for humoral response in humans after infection or vaccination. 161 32

Postmortem neuropathologic changes were evaluated in 141 consecutive patients dying with human immunodeficiency virus infection at publicly supported hospitals affiliated with the University of Texas Southwestern Medical Center in Dallas, between August 1984 and September 1990. Morphologic abnormalities were identified in 112 cases (79%). Cytomegalovirus was the most common opportunistic infection encountered, with characteristic viral inclusions identified in 23 patients, and presumptive evidence of infection in six additional patients. Progressive multifocal leukoencephalopathy was present in four patients. Gram-positive bacterial infections were identified in six patients, and mycobacterial infections in three patients. Opportunistic fungal infections included cryptococcosis (13 cases), histoplasmosis (two cases), and coccidioidomycosis (one case). Toxoplasmosis was uncommon, with active or quiescent lesions identified in five patients. Lymphoma was present in nine patients and was primary in the central nervous system in five patients. Multinucleate giant cell (human immunodeficiency virus) encephalitis was identified in 28 patients. In an additional 26 patients, microglial nodules and/or more generalized white-matter abnormalities were encountered in the absence of multinucleate giant cells, cytomegalovirus inclusions, or systemic cytomegalovirus infection. Vacuolar change was present in 21% of spinal cords, and was highly correlated with cytomegalovirus infection in the nervous system. Mixed infections and/or neoplasms were identified in 24 patients. This survey documents a high frequency of neuropathologic abnormalities in human immunodeficiency virus-infected individuals in a geographical region of the United States not represented in previous series. Variations noted in the frequencies of specific central nervous system disorders between this and other study populations reinforce the need for continuing documentation of geographical trends in human immunodeficiency virus-associated disorders.
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PMID:The neuropathology of human immunodeficiency virus infection. The Dallas, Texas, experience. 174 29

Oral lesions have rarely been reported in systemic mycoses, though over the past few years they have been recorded particularly in immunocompromised individuals. The dramatic increase in numbers of immunocompromised persons, especially those infected with human immunodeficiency virus, has almost certainly been responsible for the increase in reports of oral disease caused by systemic mycoses, particularly aspergillosis, cryptococcosis, and histoplasmosis. However, reports of coccidioidomycosis, blastomycosis, and paracoccidioidomycosis have, as yet, increased little in this population. Dentists, when they observe chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions (particularly in immunocompromised patients) should be aware of the possibility of a systemic mycosis. Amphotericin remains the standard therapy for most deep mycoses, while the newer azoles are the first-line agents for superficial mycoses, such as candidiasis, and are increasingly used in the deep mycoses.
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PMID:Oral lesions in the systemic mycoses. 180 2

With the rapid increase in cases of AIDS over the past 10 years, certain mycoses have dramatically risen in frequency, particularly those contained by T cell-mediated mechanisms of host defense. In this clinical setting mucocutaneous candidiasis as well as systemic cryptococcosis, histoplasmosis, and coccidioidomycosis pose special diagnostic and/or therapeutic challenges. Compared with fungal infections in general, AIDS-associated mycoses are more likely to have nonspecific clinical manifestations; moreover, treatments effective in other settings seldom are curative. These problems have led to new vigilance regarding mycoses in the differential diagnosis of complications of infection due to the human immunodeficiency virus (HIV) and have necessitated a redefinition of goals: the aim is now to suppress rather than cure infection in most cases. This change has stimulated trials of new antifungal agents and regimens particularly designed to facilitate long-term outpatient management of mycoses without interfering with treatment of either HIV infection itself or other concomitant complications.
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PMID:The growing problem of mycoses in patients infected with the human immunodeficiency virus. 186 53

Coccidioidomycosis is at best a complicated fungal infection; often it is life-threatening. Coccidioidomycosis is confined epidemiologically to the southwestern region of the USA, and most cases have occurred in that area, particularly in Arizona. However, we have seen several cases in San Francisco in patients with only a history of travel to endemic areas. In part because of its regional distribution, information about the clinical presentation, diagnosis, and treatment of patients with coccidioidomycosis has lagged behind information about other, more commonly encountered AIDS-associated opportunistic infections. Drs. Galgiani and Ampel have probably had the largest single experience with coccidioidomycosis in individuals infected with the human immunodeficiency virus. These specialists share their experience and make recommendations as to how these complicated conditions should be approached.
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PMID:Coccidioidomycosis in human immunodeficiency virus-infected patients. 223 Feb 41

Coccidioidomycosis in human-immunodeficiency virus-infected patients poses frequent and significant problems. Most cases are presently concentrated in regions highly endemic for the fungus. Infection most frequently involves the lungs, and diffuse reticulonodular infiltrates are typical. Disease has also been evident in extrapulmonary sites including meningitis. When progressive disease occurs, most patients already have low CD4 lymphocyte counts. In such cases, effective therapies have included amphotericin B, ketoconazole, and newer investigational agents such as itraconazole, and fluconazole. Although coccidioidal infections have developed in only a few patients away from the endemic regions, those that have suggest that reactivation is possible.
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PMID:Coccidioides immitis in patients with human immunodeficiency virus infections. 224 10

Cold abscesses are defined as having no associated erythema, heat, or tenderness. They may be present in immunodeficiency disorders, deep mycoses, and other infectious diseases. As there is a dearth information on this subject in the dermatology, surgery, and infectious disease literature, we present a case of cold abscesses secondary to coccidioidomycosis and discuss the possible role of humoral immunity, cell-mediated immunity, prostaglandins, T cells, and other mediators in cold abscess pathogenesis. In addition, therapeutic guidelines for abscesses are reviewed.
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PMID:Cold subcutaneous abscesses. 228 Apr 25

Over the last decade coccidioidomycosis, a fungal infection endemic to the desert Southwest of the United States, has gained national prominence. This review summarizes recent advances in the clinical understanding of this disease. Immunosuppressive therapy and infection with the human immunodeficiency virus are recognized risk factors for the development of severe, progressive disease. Although relatively uncommon, extrapulmonary dissemination of Coccidioides immitis can lead to chronic infection of the skin, bones, and meninges. Culture and histologic examination are important in establishment of the diagnosis, but serologic tests remain both diagnostically and prognostically useful. Treatment is problematic. Coccidioidomycosis is an unpredictable disease, and assessments of drug efficacy are difficult. Ketoconazole is challenging amphotericin B as the preferred treatment for some manifestations. However, many of the adverse effects of ketoconazole have only recently been recognized. Newer antifungal agents, such as fluconazole and itraconazole, hold promise for the future.
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PMID:Coccidioidomycosis: clinical update. 269 Feb 87


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