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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coccidioidal infection can manifest as pulmonary or extrapulmonary disease. Pulmonary coccidioidomycosis occurs in 95% of all cases and can be divided into three main categories: primary, complicated, and residual pulmonary coccidioidomycosis. The primary infection occurs with inhalation of airborne arthroconidia. As few as 10 arthroconidia are capable of causing an infection in animal models. Sixty percent of infected individuals will remain asymptomatic. This results in a positive skin test and, with rare exception, lifelong immunity. The other 40% will develop symptomatic disease that manifests with variable signs and symptoms, predominantly an influenza-like syndrome, pneumonia, or pleural effusion. The category of complicated pulmonary coccidioidomycosis includes clinical entities as severe and persistent pneumonia, progressive primary coccidioidomycosis, fibrocavitary coccidioidomycosis, cavities, and empyema, a complication of a ruptured cavity. Progression of primary pulmonary disease to acute respiratory distress syndrome (ARDS) can also qualify as a complication. The third category of residual disease comprises only two entities: pulmonary nodule and fibrosis. This review focuses on uncomplicated and complicated pulmonary coccidioidomycosis and its management as outlined earlier in addition to special considerations of coccidioidal fungemia, pulmonary coccidioidomycosis in pregnancy, and organ transplantation.
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PMID:Pulmonary coccidioidomycosis. 1836 98

Pulmonary coccidioidomycosis is a fungal disease endemic to the desert regions of the southwestern United States, Mexico, Central America, and South America. The incidence of reported disease increased substantially between 1998 and 2011, and the infection is encountered beyond the endemic areas because of a mobile society. The disease is caused by inhalation of spores of Coccidioides species. Individuals at high risk are those exposed to frequent soil aerosolization. The diagnosis is established by direct visualization of mature spherules by using special stains or cultures from biologic specimens. Serologic testing of anticoccidioidal antibodies is used for diagnosis and treatment monitoring. The infection is self-limited in 60% of cases. When the disease is symptomatic, the lung is the primary site of involvement. On the basis of clinical presentation and imaging abnormalities, pulmonary involvement is categorized into acute, disseminated, and chronic forms, each with a spectrum of imaging findings. In patients with acute disease, the most common findings are lobar or segmental consolidation, multifocal consolidation, and nodules. Adenopathy and pleural effusions are also seen, usually in association with parenchymal disease. Disseminated disease is rare and occurs in less than 1% of patients. Pulmonary findings are miliary nodules and confluent parenchymal opacities. Acute respiratory distress syndrome is an infrequent complication of disseminated disease. The acute findings resolve in most patients, with chronic changes developing in approximately 5% of patients. Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes. Unusual complications of chronic disease are mycetoma, abscess formation, and bronchopleural fistula. Patients in an immunocompromised state, those with diabetes mellitus, pregnant women, and those belonging to certain ethnic groups may show severe, progressive, or disseminated disease.
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PMID:Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings. 2501 31

Primary pulmonary coccidioidomycosis (valley fever) is caused by inhaling airborne spores of the fungus Coccidioides immitis or Coccidioides posadasii. Residing in or traveling to areas endemic for Coccidioides is required for the diagnosis; no person-to-person or zoonotic contagion occurs. The incidence of coccidioidomycosis is increasing in endemic areas, and it has been identified as the cause of as many as 17% to 29% of all cases of community-acquired pneumonia in some regions. Obtaining a travel history is recommended when evaluating patients with community-acquired pneumonia. Diagnosis usually relies on enzyme immunoassay with immunodiffusion confirmation, but these tests may not be positive for one to three weeks after disease onset. Antifungal agents are not recommended for treatment unless the patient is at risk of or shows signs of complicated or disseminated infection. When antifungals are used, fluconazole and itraconazole are most commonly recommended, except during pregnancy. Treatment may continue for as long as three to 12 months, although lifetime treatment is indicated for patients with coccidioidal meningitis. Monitoring of complement fixation titers and chest radiography is recommended until patients stabilize and symptoms resolve. In patients who are treated with antifungals, complement fixation titers should be followed for at least two years.
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PMID:Coccidioidomycosis (Valley Fever) in Primary Care. 3205 27