Coccidioidomycosis
Demosthenes Pappagianis, M.D., Ph.D.
University of California, Davis
November 2011
Infections/
100,000
Population
Total
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Institution*
Pleasant Valley SP
Avenal SP
Cal SP, Corcoran
Cal Men's Colony, San Luis Obispo
Cal SP, Los Angeles Co, Lancaster
Kern Valley SP
Cal Corr Ctr, Susanville
Cal Corr Inst, Tehachapi
Cal SATF and SP, Corcoran
Corr Training Fac, Soledad
Mule Creek SP
Cal Rehab Ctr, Norco
RJ Donovan Corr Fac, San Diego
Sierra Conserv Ctr, Jamestown
Deuel Vocational Inst, Tracy
Cal Medical Fac, Vacaville
High Desert SP, Susanville
Cal Inst for Women, Corona
Cal SP, Calipatria
Cal SP, San Quentin
Cal SP, Solano
Chuckwalla Valley SP
Valley SP, Chowchilla
Totals:
Jan
Coccidioidal Infections for 2010 in California State Prisons
18 6 8 13 6 18 33 44 62 71 41 37 357 4647
7682
5 3 3 4 7 10 9 41 49 52 27 6 216 5723
3774
4 2 1 1 0 2 1 1 4 5 4 3 28 4876
574
1 0 2 1 0 2 0 0 4 6 5 2 23 6139
375
3 0 1 0 3 5 3 0 2 2 3 0 22 4356
505
0 3 1 1 1 0 1 4 3 4 1 0 19 4663
407
0 0 0 1 0 0 0 1 3 1 1 0
7 5460
128
2 0 0 0 0 0 0 0 1 0 3 1
7 5519
127
0 1 1 0 1 0 0 0 1 1 2 0
7 6082
115
1 2 0 0 0 0 2 1 0 0 0 0
6 6538
92
2 0 0 0 0 2 0 1 0 0 0 1
6 3523
170
0 0 0 2 0 0 1 0 0 0 1 0
4 4132
97
2 0 0 0 0 0 0 2 0 0 0 0
4 4369
92
0 0 0 0 0 0 1 1 0 2 0 0
4 5314
75
0 0 1 0 0 0 0 0 0 2 0 0
3 3785
79
1 0 1 0 0 0 0 0 0 0 0 0
2 2737
73
0 0 1 0 0 0 0 0 0 0 0 1
2 4128
48
0 0 0 0 0 1 0 0 0 0 0 0
1 2071
48
0 0 0 0 0 0 0 0 0 1 0 0
1 4153
24
0 0 0 0 0 0 0 0 0 0 1 0
1 4983
20
0 1 0 0 0 0 0 0 0 0 0 0
1 5022
20
0 0 0 0 0 0 0 0 1 0 0 0
1 3159
32
0 0 0 0 0 0 0 0 0 0 0 0
0 3296
0
39 18 20 23 18 40 51 96 130 147 89 51 722 104675 14559
80
2
60
1.5
40
1
20
0.5
0
Coalinga Rainfall
INCHES RAIN
NUMBER OF CASES
Comparing Rainfall to Coccidioidal
Infections at Two Prisons
0
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 Silveira
Second case,
recognized in
California
(1894)
Dye Creek
Coccidioidomycosis California Endemic
Areas
Soledad
Paso Robles
Coalinga Avenal
Calif. Men’s Colony
Corcoran
Tecate
Otay
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
Infant died; mother
survived 5 years
Larwood,
1962
Human with transplanted
lung
Donor with pulmonary coccidioidomycosis
Survived
Tripathy et al.,
2002
Human with
transplanted kidney
Human with
transplanted liver
Donor with (unknown)
prior disseminated coccy
Fatal
Wright et al.,
2003
“
“
Human with transplanted
lung
Donor with quiescent
coccidioidomycosis of lungs
Fatal
Female with pelvic/
abdominal coccy
Husband’s semen – artificial
insemination
Living
Fatal
Miller et al.,
2004
H. Chope
1929
Coccidioidal
Erythema
Nodosum
Night sweats,
Anorexia
( Pappagianis 1998)
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,
Bestebreurtje et al.
(1946)
(1967)
Sievers
Number of
Patients:
50
20
Lung
Spleen
Liver
Kidney
Skin &Subcut.
Bone
Leptomeninges
Adrenal
%
86
70
60
60
64
48
36
32
131
%
86
51
45
35
21
16
*63
17
Total
(1974)
%
60
25
35
48
0
22
**55
20
Sievers
(1974)
201
16
%
84
53
48
41
29
22
55
21
%
25
0
0
0
31
13
13
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
