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Siler AD, Jaffey JA, Jacobs C, Shumway K. Diagnostic Contribution of Bronchoalveolar Lavage Sampling and Fungal Culture in a Dog With Pulmonary Coccidioidomycosis. Top Companion Anim Med 2023; 52:100754. [PMID: 36538969 DOI: 10.1016/j.tcam.2022.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
A 7-year-old, male neutered, Miniature Australian Shepherd from Arizona was presented for evaluation of a 3-month history of progressive cough. Thoracic radiographs revealed a focal alveolar pulmonary pattern and suspected tracheobronchial lymph node enlargement. Serum anti-Coccidioides spp. IgM/IgG antibodies were not detected by agar gel immunodiffusion performed by 2 different reference commercial veterinary laboratories approximately 3.5 and 3.75 months after respiratory tract signs were first noted. The dog failed to respond to empiric therapy with a cough suppressant and various antibiotics. Tracheobronchoscopy and bronchoalveolar lavage (BAL) were subsequently performed and cytological examination of the BAL fluid identified marked neutrophilic inflammation characterized by mildly degenerate neutrophils and no infectious organisms. Bacterial cultures were negative but fungal cultures revealed growth of Coccidioides spp. Clinical signs improved shortly after initiation of fluconazole administration and the dog achieved long-term sustained clinical remission. Here, we provide a description of a dog with pulmonary coccidioidomycosis diagnosed with fungal culture of BAL fluid. Airway sampling with cytological examination and fungal culture should be considered in dogs with persistent respiratory related clinical signs, negative antibody serology, and that have lived in or traveled to endemic areas.
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Affiliation(s)
- Alexis D Siler
- Department of Primary Care, Midwestern University College of Veterinary Medicine, Glendale, AZ, USA
| | - Jared A Jaffey
- Department of Specialty Medicine, Midwestern University College of Veterinary Medicine, Glendale, AZ, USA.
| | - Casandra Jacobs
- Department of Internal Medicine, Desert Veterinary Medical Specialists, Peoria, AZ, USA
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Abe T, Yamaguchi F, Sakakura S, Shiratori Y, Mase A, Funaki T, Kamio Y, Suzuki T, Shikama Y, Hoshino Y. Surgical Resection to Treat a Japanese Patient with Pulmonary Coccidioidomycosis. Infect Drug Resist 2023; 16:2787-2791. [PMID: 37187484 PMCID: PMC10178290 DOI: 10.2147/idr.s401752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Coccidioidomycosis is an endemic disease that is particularly prevalent in the United States. However, its geographic distribution is becoming widespread. Here, we present a Japanese male who resided in the United States for 1 year, where he was diagnosed with pulmonary coccidioidomycosis that was accompanied by cavity formation. He did not tolerate antifungal therapy and consequently underwent partial resection of the upper lobe of his left lung upon his return to Japan. The patient's symptoms improved after surgery. The trend toward global networking and logistics means that a diagnosis of coccidioidomycosis should be considered in routine practice in nonendemic areas. Due to the rarity of surgical treatment for this disease, prolonged follow-up is necessary. During the last follow-up, the patient was symptom-free.
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Affiliation(s)
- Takashi Abe
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Correspondence: Fumihiro Yamaguchi, Department of Respiratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan, Tel +81-45-971-1151, Email
| | - Shunsuke Sakakura
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yo Shiratori
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ayaka Mase
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Toshitaka Funaki
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshito Kamio
- Departments of Thoracic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takashi Suzuki
- Departments of Thoracic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yusuke Shikama
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yasutaka Hoshino
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
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Duttke SH, Beyhan S, Singh R, Neal S, Viriyakosol S, Fierer J, Kirkland TN, Stajich JE, Benner C, Carlin AF. Decoding Transcription Regulatory Mechanisms Associated with Coccidioides immitis Phase Transition Using Total RNA. mSystems 2022; 7:e0140421. [PMID: 35076277 PMCID: PMC8788335 DOI: 10.1128/msystems.01404-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 01/07/2023] Open
Abstract
New or emerging infectious diseases are commonly caused by pathogens that cannot be readily manipulated or studied under common laboratory conditions. These limitations hinder standard experimental approaches and our abilities to define the fundamental molecular mechanisms underlying pathogenesis. The advance of capped small RNA sequencing (csRNA-seq) now enables genome-wide mapping of actively initiated transcripts from genes and other regulatory transcribed start regions (TSRs) such as enhancers at a precise moment from total RNA. As RNA is nonpathogenic and can be readily isolated from inactivated infectious samples, csRNA-seq can detect acute changes in gene regulation within or in response to a pathogen with remarkable sensitivity under common laboratory conditions. Studying valley fever (coccidioidomycosis), an emerging endemic fungal infection that increasingly impacts livestock, pet, and human health, we show how csRNA-seq can unravel transcriptional programs driving pathogenesis. Performing csRNA-seq on RNA isolated from different stages of the valley fever pathogen Coccidioides immitis revealed alternative promoter usage, connected cis-regulatory domains, and a WOPR family transcription factor, which are known regulators of virulence in other fungi, as being critical for pathogenic growth. We further demonstrate that a C. immitis WOPR homologue, CIMG_02671, activates transcription in a WOPR motif-dependent manner. Collectively, these findings provide novel insights into valley fever pathogenesis and provide a proof of principle for csRNA-seq as a powerful means to determine the genes, regulatory mechanisms, and transcription factors that control the pathogenesis of highly infectious agents. IMPORTANCE Infectious pathogens like airborne viruses or fungal spores are difficult to study; they require high-containment facilities, special equipment, and expertise. As such, establishing approaches such as genome editing or other means to identify the factors and mechanisms underlying caused diseases, and, thus, promising drug targets, is costly and time-intensive. These obstacles particularly hinder the analysis of new, emerging, or rare infectious diseases. We recently developed a method termed capped small RNA sequencing (csRNA-seq) that enables capturing acute changes in active gene expression from total RNA. Prior to csRNA-seq, such an analysis was possible only by using living cells or nuclei, in which pathogens are highly infectious. The process of RNA purification, however, inactivates pathogens and thus enables the analysis of gene expression during disease progression under standard laboratory conditions. As a proof of principle, here, we use csRNA-seq to unravel the gene regulatory programs and factors likely critical for the pathogenesis of valley fever, an emerging endemic fungal infection that increasingly impacts livestock, pet, and human health.
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Affiliation(s)
- Sascha H. Duttke
- Department of Medicine, Division of Endocrinology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Sinem Beyhan
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
- J. Craig Venter Institute, Department of Infectious Diseases, La Jolla, California, USA
| | - Rajendra Singh
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
| | - Sonya Neal
- Section of Cell and Developmental Biology, Division of Biological Sciences, University of California, San Diego, La Jolla, California, USA
| | - Suganya Viriyakosol
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
| | - Joshua Fierer
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
- Infectious Diseases Section, VA Healthcare San Diego, San Diego, California, USA
- Department of Pathology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Theo N. Kirkland
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
- Department of Pathology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Jason E. Stajich
- Department of Microbiology and Plant Pathology, Institute for Integrative Genome Biology, University of California—Riverside, Riverside, California, USA
| | - Christopher Benner
- Department of Medicine, Division of Endocrinology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Aaron F. Carlin
- Department of Medicine, Division of Infectious Disease, UC San Diego School of Medicine, La Jolla, California, USA
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Ramírez Zamora JA, Delgadillo Vargas JA, Medina González R, Hayakawa Dávila VC, Acevedo Rodarte AY, Arellano Pérez Vertti RD. Coccidioidomycosis Osteomyelitis of Distal Tibia in a Preschool Girl: A Case Report. J Orthop Case Rep 2022; 12:66-69. [PMID: 36660146 PMCID: PMC9826543 DOI: 10.13107/jocr.2022.v12.i05.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/12/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Coccidioides immitis is a fungus that develops in endemic areas characterized by dry climates, with little rainfall and easy aerial dissemination. The most common form of infection is pulmonary coccidioidomycosis, although it is often asymptomatic. There are non-respiratory forms of this disease. Osteomyelitis is an extrapulmonary manifestation of C. immitis infection. Symptoms are usually nonspecific and radiographic findings are often confused with bone tumors. Treatment of coccidioidal osteomyelitis is often challenging. Case Presentation We report a case of a 3-year-old preschool girl from an endemic area for coccidioidomycosis who presented with pain and swelling on her left ankle. Initially, antibiotic treatment is administered for a suspected insect bite. However, her symptoms worsened and X-rays showed a lytic-like lesión. She was admitted to the hospital for biopsy and drainage surgery. The histopathological study confirms coccidioidomycosis osteomyelitis. She was started on long-term anti-fungal treatment. At 6-month follow-up, symptoms and signs of infection have been solved and X-ray image shows evidence of bone healing. Conclusion It is important to take into account aspects related to exposure to this fungus, such as the patient's place of residence and recent trips so that the diagnostic and therapeutic approach is appropriate. Coccidioidal osteomyelitis is an infrequent pathology, especially in patients without other comorbidities. Treatment is complex and often requires not only antifungal drugs but also surgical debridement.
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Affiliation(s)
- José Arturo Ramírez Zamora
- Department of Orthopaedic Surgery, Universidad Autónoma de Coahuila, Facultad de Medicina Torreón, Torreón, Coahuila, Mexico
| | - José Abraham Delgadillo Vargas
- Department of Orthopaedic Surgery, Universidad Autónoma de Coahuila, Facultad de Medicina Torreón, Torreón, Coahuila, Mexico
| | - Roberto Medina González
- Department of Orthopaedic Surgery, Universidad Autónoma de Coahuila, Facultad de Medicina Torreón, Torreón, Coahuila, Mexico
| | | | | | - Rubén Daniel Arellano Pérez Vertti
- Department of Orthopaedic Surgery, Universidad Autónoma de Coahuila, Facultad de Medicina Torreón, Torreón, Coahuila, Mexico,Address of Correspondence: Dr. Rubén Daniel Arellano Pérez Vertti, Department of Orthopaedic Surgery, Universidad Autónoma de Coahuila, Facultad de Medicina Torreón, Avenida Morelos 900 Oriente, Zip Code 27000, Torreón Coahuila, Mexico. E-mail:
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5
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Lee G, Scott GA, Munsiff SS, Richardson CT. Locally recurrent primary cutaneous coccidioidomycosis. JAAD Case Rep 2021; 16:161-163. [PMID: 34632028 PMCID: PMC8493489 DOI: 10.1016/j.jdcr.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Gayin Lee
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Glynis A Scott
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.,Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Sonal S Munsiff
- Division of Infectious Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher T Richardson
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.,Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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Carey A, Gorris ME, Chiller T, Jackson B, Beadles W, Webb BJ. Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006-2015. Emerg Infect Dis 2021; 27:2269-2277. [PMID: 34423764 PMCID: PMC8386810 DOI: 10.3201/eid2709.210751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
On the basis of a 1957 geographic Coccidioides seropositivity survey, 3 counties in southwestern Utah, USA, were considered coccidioidomycosis-endemic, but there has been a paucity of information on the disease burden in Utah since. We report findings from a recent clinical and epidemiologic study of coccidioidomycosis in Utah. To describe clinical characteristics, we identified all coccidioidomycosis cases in an integrated health system in the state during 2006-2015. For epidemiologic analysis, we used cases reported to the Utah Department of Health during 2009-2015. Mean state incidence was 1.83 cases/100,000 population/year. Washington County, in southwestern Utah, had the highest incidence, 17.2 cases/100,000 population/year. In a generalized linear model with time as a fixed effect, mean annual temperature, population, and new construction were associated with regional variations in incidence. Using these variables in a spatiotemporal model, we estimated the adjusted regional variation by county to predict areas where Coccidioides infections might increase.
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Diep AL, Tejeda-Garibay S, Miranda N, Hoyer KK. Macrophage and Dendritic Cell Activation and Polarization in Response to Coccidioidesposadasii Infection. J Fungi (Basel) 2021; 7:jof7080630. [PMID: 34436169 PMCID: PMC8397226 DOI: 10.3390/jof7080630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Coccidioidomycosis is a fungal, respiratory disease caused by Coccidioides immitis and Coccidioides posadasii. The host immune responses that define disease outcome during infection are largely unknown, although T helper responses are required. Adaptive immunity is influenced by innate immunity as antigen-presenting cells activate and educate adaptive responses. Macrophage and dendritic cell (DC) recognition of pathogen surface molecules are critical for Coccidioides clearance. We characterize the broad innate immune responses to Coccidioides by analyzing macrophage and dendritic cell responses to Coccidioides arthroconidia using avirulent, vaccine Coccidioides strain NR-166 (Δcts2/Δard1/Δcts3), developed from parental virulent strain C735. We developed a novel flow cytometry-based method to analyze macrophage phagocytosis to complement traditional image-scoring methods. Our study found that macrophage polarization is blocked at M0 phase and activation reduced, while DCs polarize into proinflammatory DC1s, but not anti-inflammatory DC2, following interaction with Coccidioides. However, DCs exhibit a contact-dependent reduced activation to Coccidioides as defined by co-expression of MHC-II and CD86. In vivo, only modest DC1/DC2 recruitment and activation was observed with avirulent Coccidioides infection. In conclusion, the vaccine Coccidioides strain recruited a mixed DC population in vivo, while in vitro data suggest active innate immune cell inhibition by Coccidioides.
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Affiliation(s)
- Anh L. Diep
- Quantitative Systems Biology Graduate Programme, University of California Merced, Merced, CA 95343, USA; (A.L.D.); (S.T.-G.); (N.M.)
| | - Susana Tejeda-Garibay
- Quantitative Systems Biology Graduate Programme, University of California Merced, Merced, CA 95343, USA; (A.L.D.); (S.T.-G.); (N.M.)
| | - Nadia Miranda
- Quantitative Systems Biology Graduate Programme, University of California Merced, Merced, CA 95343, USA; (A.L.D.); (S.T.-G.); (N.M.)
| | - Katrina K. Hoyer
- Quantitative Systems Biology Graduate Programme, University of California Merced, Merced, CA 95343, USA; (A.L.D.); (S.T.-G.); (N.M.)
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA 95343, USA
- Health Sciences Research Institute, University of California Merced, Merced, CA 95343, USA
- Correspondence: ; Tel.: +1-(209)-228-4229
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8
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Carlin AF, Beyhan S, Peña JF, Stajich JE, Viriyakosol S, Fierer J, Kirkland TN. Transcriptional Analysis of Coccidioides immitis Mycelia and Spherules by RNA Sequencing. J Fungi (Basel) 2021; 7:jof7050366. [PMID: 34067070 PMCID: PMC8150946 DOI: 10.3390/jof7050366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coccidioides immitis and C. posadasii are dimorphic fungi that transform from mycelia with internal arthroconidia in the soil to a tissue form known as a spherule in mammals. This process can be recapitulated in vitro by increasing the temperature, CO2 and changing other culture conditions. In this study, we have analyzed changes in gene expression in mycelia and young and mature spherules. Genes that were highly upregulated in young spherules include a spherule surface protein and iron and copper membrane transporters. Genes that are unique to Coccidioides spp. are also overrepresented in this group, suggesting that they may be important for spherule differentiation. Enriched GO terms in young spherule upregulated genes include oxidation-reduction, response to stress and membrane proteins. Downregulated genes are enriched for transcription factors, especially helix–loop–helix and C2H2 type zinc finger domain-containing proteins, which is consistent with the dramatic change in transcriptional profile. Almost all genes that are upregulated in young spherules remain upregulated in mature spherules, but a small number of genes are differentially expressed in those two stages of spherule development. Mature spherules express more Hsp31 and amylase and less tyrosinase than young spherules. Some expression of transposons was detected and most of the differentially expressed transposons were upregulated in spherules.
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Affiliation(s)
- Aaron F. Carlin
- Department of Medicine, Division of Infectious Disease, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA; (A.F.C.); (S.V.); (J.F.)
| | - Sinem Beyhan
- J. Craig Venter Institute, La Jolla, CA 92037, USA;
| | - Jesús F. Peña
- Department of Microbiology and Plant Pathology, Institute for Integrative Genome Biology, University of California-Riverside, Riverside, CA 92521, USA; (J.F.P.); (J.E.S.)
| | - Jason E. Stajich
- Department of Microbiology and Plant Pathology, Institute for Integrative Genome Biology, University of California-Riverside, Riverside, CA 92521, USA; (J.F.P.); (J.E.S.)
| | - Suganya Viriyakosol
- Department of Medicine, Division of Infectious Disease, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA; (A.F.C.); (S.V.); (J.F.)
| | - Joshua Fierer
- Department of Medicine, Division of Infectious Disease, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA; (A.F.C.); (S.V.); (J.F.)
- Infectious Diseases Section, VA Healthcare San Diego, San Diego, CA 92161, USA
- Department of Pathology, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Theo N. Kirkland
- Department of Medicine, Division of Infectious Disease, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA; (A.F.C.); (S.V.); (J.F.)
- Department of Pathology, U.C. San Diego School of Medicine, La Jolla, CA 92093, USA
- Correspondence:
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Trainor M, Henkel E, Diaz LZ, Carrasco R. Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab. Pediatr Rheumatol Online J 2021; 19:63. [PMID: 33933122 PMCID: PMC8088673 DOI: 10.1186/s12969-021-00549-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coccidioides immitis is a dimorphic fungus endemic to the arid climates of the Southwest United States, Mexico and parts of Central and South America. Human infection occurs through inhalation of spores with less than half of exposures progressing to a symptomatic state that primarily consists of pulmonary manifestations. Disseminated coccidioidomycosis is exceedingly rare, occurring in fewer than 1 % of symptomatic infections. Through hematogenous spread, the fungus can infect most organ systems and may be fatal without systemic antifungal treatment. Individuals with impaired cell-mediated immunity either from primary immunodeficiency disorders or secondary to immunosuppression with medications such as tumor necrosis factor alpha (TNF-α) inhibitors have increased risk of disseminated coccidioidomycosis and previous cases of coccidioidomycosis have been reported with biologic therapy. CASE PRESENTATION We present a case of disseminated coccidioidomycosis in a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) being treated with prednisone, methotrexate, and infliximab. The patient presented with symptoms of meningeal irritation, bilateral choroidal lesions, and necrotizing peripheral pneumonia. Her infection was thought to be a reactivation of coccidioidomycosis given her history of resolved pneumonia that occurred after traveling to Arizona, New Mexico, and El Paso one year prior to presentation. Following diagnosis, she improved with discontinuation of her immunosuppressive medications and two weeks of intravenous amphotericin B and fluconazole with plans for lifetime treatment with fluconazole while immunosuppressed. Due to worsening arthritis, she will begin tofacitinib and continue close monitoring of chest x-rays and coccidioides antibody. CONCLUSIONS Patients undergoing immunosuppressive therapy for rheumatological conditions are at increased risk of disseminated coccidioidomycosis and should be evaluated with high suspicion when presenting with atypical symptoms and history of travel to endemic regions.
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Affiliation(s)
- Megan Trainor
- Division of Dermatology, Dell Medical School, University of Texas at Austin, 601 E 15th St, CEC C2.470 , Austin, TX, 78701 , USA.
| | - Emily Henkel
- grid.267309.90000 0001 0629 5880Long School of Medicine, University of Texas Health Science Center at San Antonio, Texas San Antonio, USA
| | - Lucia Z. Diaz
- grid.89336.370000 0004 1936 9924Division of Dermatology, Dell Medical School, University of Texas at Austin, 601 E 15th St, CEC C2.470 , Austin, TX 78701 USA ,grid.413578.c0000 0004 0637 322XDell Children’s Medical Center, Texas Austin, USA ,grid.89336.370000 0004 1936 9924Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas USA
| | - Ruy Carrasco
- grid.487005.e0000 0004 0368 0216Presbyterian Healthcare Services, New Mexico Albuquerque, USA
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10
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Abstract
Coccidioidomycosis is a fungal, respiratory disease caused by Coccidioides immitis and Coccidioides posadasii. This emerging infectious disease ranges from asymptomatic to pulmonary disease and disseminated infection. Most infections are cleared with little to no medical intervention whereas chronic disease often requires life-long medication with severe impairment in quality of life. It is unclear what differentiates hosts immunity resulting in disease resolution versus chronic infection. Current understanding in mycology-immunology suggests that chronic infection could be due to maladaptive immune responses. Immunosuppressed patients develop more severe disease and mouse studies show adaptive Th1 and Th17 responses are required for clearance. This is supported by heightened immunosuppressive regulatory responses and lowered anti-fungal T helper responses in chronic Coccidioides patients. Diagnosis and prognosis is difficult as symptoms are broad and overlapping with community acquired pneumonia, often resulting in misdiagnosis and delayed treatment. Furthermore, we lack clear biomarkers of disease severity which could aid prognosis for more effective healthcare. As the endemic region grows and population increases in endemic areas, the need to understand Coccidioides infection is becoming urgent. There is a growing effort to identify fungal virulence factors and host immune components that influence fungal immunity and relate these to patient disease outcome and treatment. This review compiles the known immune responses to Coccidioides spp. infection and various related fungal pathogens to provide speculation on Coccidioides immunity.
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Affiliation(s)
- Anh L. Diep
- Quantitative and Systems Biology, Graduate Program, University of California Merced, Merced, CA, United States
| | - Katrina K. Hoyer
- Quantitative and Systems Biology, Graduate Program, University of California Merced, Merced, CA, United States
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, United States
- Health Sciences Research Institute, University of California Merced, Merced, CA, United States
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11
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Jenks JD, Reed SL, Hoenigl M. Risk factors and outcomes of culture-proven acute Coccidioides spp. infection in San Diego, California, United States. Mycoses 2020; 63:553-557. [PMID: 32176829 DOI: 10.1111/myc.13074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coccidioides spp. are dimorphic fungi endemic to parts of the United States, Mexico, Central and South America. Infection can cause a range of disease from self-limited acute pneumonia to severe disseminated disease. METHODS We performed a retrospective chart review of medical records of cases of culture-proven acute coccidioidomycosis at the University of California San Diego between 1 April 2015 and 31 December 2019 and described the demographics, risk factors and outcomes of these cases. RESULTS Over the study period, fifteen evaluable cases of culture-proven acute coccidioidomycosis were identified. Of these, 87% (13/15) had traditional risk factors for coccidioidomycosis infection while two lacked known risk factors, including one patient with cirrhosis and one with chronic hepatitis C infection. Seven of fifteen (47%) had primary coccidioidomycosis of the lungs without dissemination and 7/15 (47%) disseminated disease. Of those with disseminated disease, 6/7 (86%) had either high-risk ethnicity or blood type as their only risk factor. At 90 days, 11/15 (73%) were alive, 3/15 (20%) deceased and 1/15 (7%) lost to follow-up. Of those not alive at 90 days, 1/3 (33%) had disseminated disease and 2/3 (67%) primary coccidioidomycosis, both on immunosuppressive therapy. DISCUSSION Coccidioides spp. infection occurs in a variety of hosts with varying underlying risk factors, with the majority in our cohort overall and 86% with disseminated disease lacking traditional risk factors for invasive fungal infection other than ethnicity and/or blood phenotype. Clinicians should be aware of these non-traditional risk factors in patients with coccidioidomycosis infection.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California San Diego, La Jolla, California.,Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, California
| | - Sharon L Reed
- Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, California.,Department of Pathology, University of California San Diego, La Jolla, California.,Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, California
| | - Martin Hoenigl
- Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, California.,Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, California
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12
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Oltean HN, Springer M, Bowers JR, Barnes R, Reid G, Valentine M, Engelthaler DM, Toda M, McCotter OZ. Suspected Locally Acquired Coccidioidomycosis in Human, Spokane, Washington, USA. Emerg Infect Dis 2020; 26:606-609. [PMID: 31922952 PMCID: PMC7045822 DOI: 10.3201/eid2603.191536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The full geographic range of coccidioidomycosis is unknown, although it is most likely expanding with environmental change. We report an apparently autochthonous coccidioidomycosis patient from Spokane, Washington, USA, a location to which Coccidioides spp. are not known to be endemic.
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13
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Brown EM, McTaggart LR, Dunn D, Pszczolko E, Tsui KG, Morris SK, Stephens D, Kus JV, Richardson SE. Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990-2015. Emerg Infect Dis 2019; 24:1257-1266. [PMID: 29912691 PMCID: PMC6038754 DOI: 10.3201/eid2407.172063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Elevated incidence of blastomycosis in Ontario calls for diagnostic vigilance. Endemic mycoses represent a growing public health challenge in North America. We describe the epidemiology of 1,392 microbiology laboratory–confirmed cases of blastomycosis, histoplasmosis, and coccidioidomycosis in Ontario during 1990–2015. Blastomycosis was the most common infection (1,092 cases; incidence of 0.41 cases/100,000 population), followed by histoplasmosis (211 cases) and coccidioidomycosis (89 cases). Incidence of blastomycosis increased from 1995 to 2001 and has remained elevated, especially in the northwest region, incorporating several localized hotspots where disease incidence (10.9 cases/100,000 population) is 12.6 times greater than in any other region of the province. This retrospective study substantially increases the number of known endemic fungal infections reported in Canada, confirms Ontario as an important region of endemicity for blastomycosis and histoplasmosis, and provides an epidemiologic baseline for future disease surveillance. Clinicians should include blastomycosis and histoplasmosis in the differential diagnosis of antibiotic-refractory pneumonia in patients traveling to or residing in Ontario.
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14
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Lauer A, Baal JD, Mendes SD, Casimiro KN, Passaglia AK, Valenzuela AH, Guibert G. Valley Fever on the Rise-Searching for Microbial Antagonists to the Fungal Pathogen Coccidioides immitis. Microorganisms 2019; 7:E31. [PMID: 30682831 PMCID: PMC6406340 DOI: 10.3390/microorganisms7020031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 11/16/2022] Open
Abstract
The incidence of coccidioidomycosis, also known as Valley Fever, is increasing in the Southwestern United States and Mexico. Despite considerable efforts, a vaccine to protect humans from this disease is not forthcoming. The aim of this project was to isolate and phylogenetically compare bacterial species that could serve as biocontrol candidates to suppress the growth of Coccidioides immitis, the causative agent of coccidioidomycosis, in eroded soils or in areas close to human settlements that are being developed. Soil erosion in Coccidioides endemic areas is leading to substantial emissions of fugitive dust that can contain arthroconidia of the pathogen and thus it is becoming a health hazard. Natural microbial antagonists to C. immitis, that are adapted to arid desert soils could be used for biocontrol attempts to suppress the growth of the pathogen in situ to reduce the risk for humans and animals of contracting coccidioidomycosis. Bacteria were isolated from soil samples obtained near Bakersfield, California. Subsequently, pairwise challenge assays with bacterial pure cultures were initially performed against Uncinocarpus reesii, a non-pathogenic relative of C. immitis on media plates. Bacterial isolates that exhibited strongly antifungal properties were then re-challenged against C. immitis. Strongly anti-C. immitis bacterial isolates related to Bacillus subtilis and Streptomyces spp. were isolated, and their antifungal spectrum was investigated using a selection of environmental fungi.
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Affiliation(s)
- Antje Lauer
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Joe Darryl Baal
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Susan D Mendes
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Kayla Nicole Casimiro
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Alyce Kayes Passaglia
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Alex Humberto Valenzuela
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311-1022, USA.
| | - Gerry Guibert
- Monterey County Health Department, 1270 Natividad, Salinas, CA 93906, USA.
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15
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Weaver EA, Kolivras KN. Investigating the Relationship Between Climate and Valley Fever (Coccidioidomycosis). Ecohealth 2018; 15:840-852. [PMID: 30284073 DOI: 10.1007/s10393-018-1375-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 05/21/2023]
Abstract
Valley fever (coccidioidomycosis) is a disease caused by inhalation of spores from the soil-dwelling Coccidioides fungal species. The disease is endemic to semiarid areas in the western USA and parts of Central and South America. The region of interest for this study, Kern County, California, accounts for approximately 14% of the reported valley fever cases in the USA each year. It is hypothesized that the weather conditions that foster the growth and dispersal of the fungus influence the number of cases in the endemic area. This study uses regression-based analysis to model and assess the seasonal relationships between valley fever incidence and climatic variables including concurrent and lagged precipitation, temperature, Palmer Drought Severity Index, wind speed, and PM10 using data from 2000 to 2015. We find statistically significant links between disease incidence and climate conditions in Kern County, California. The best performing seasonal model explains up to 76% of the variability in fall valley fever incidence based on concurrent and antecedent climate conditions. Findings are consistent with previous studies, suggesting that antecedent precipitation is an important predictor of disease. The significant relationships found support the "grow and blow" hypothesis for climate-related coccidioidomycosis incidence risk that was originally developed for Arizona.
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Affiliation(s)
- Elizabeth A Weaver
- Virginia Polytechnic Institute and State University, 115 Major Williams Hall, Blacksburg, VA, 4061, USA.
| | - Korine N Kolivras
- Virginia Polytechnic Institute and State University, 115 Major Williams Hall, Blacksburg, VA, 4061, USA
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16
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Wiederhold NP, Najvar LK, Jaramillo R, Olivo M, Birch M, Law D, Rex JH, Catano G, Patterson TF. The Orotomide Olorofim Is Efficacious in an Experimental Model of Central Nervous System Coccidioidomycosis. Antimicrob Agents Chemother 2018; 62:e00999-18. [PMID: 29941638 DOI: 10.1128/AAC.00999-18] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Olorofim (formerly F901318) is an advanced analog of the orotomide class that inhibits fungal pyrimidine biosynthesis. We evaluated the in vitro and in vivo activities of olorofim against Coccidioides species. In vitro activity was assessed against 59 clinical Coccidioides isolates. Central nervous system infections were established in mice via intracranial inoculation with Coccidioides immitis arthroconidia. Oral therapy began 48 h postinoculation and consisted of vehicle control, olorofim daily doses of 20 mg/kg (6.67 mg/kg three times daily or 10 mg/kg twice daily) or 40 mg/kg (13.3 mg/kg three times daily or 20 mg/kg twice daily), or fluconazole (25 mg/kg twice daily). Treatment continued for 7 and 14 days in the fungal burden and survival arms, respectively. Fungal burdens were assessed by CFU counts in brains. Olorofim demonstrated potent in vitro activity (MIC range, ≤0.008 to 0.06 μg/ml). Survival was significantly enhanced in mice treated with olorofim. Reductions in brain tissue fungal burdens were also observed on day 9 in the olorofim-treated groups. Improvements in survival and reductions in fungal burdens also occurred with fluconazole. More frequent dosing of olorofim was associated with enhanced survival and greater reductions in fungal burdens. In the group treated with 13.3 mg/kg olorofim three times daily, fungal burdens remained low on day 30 (15 days after treatment was stopped), with undetectable levels in 7 of 10 mice. In contrast, fungal burdens rebounded in all other groups after therapy stopped. Olorofim was highly active in vitro and in vivo against Coccidioides These results demonstrate that olorofim may have a role in the treatment of coccidioidomycosis.
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17
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Abstract
Coccidioidomycosis is a fungal disease caused by either Coccidioides immitis or Coccidioides posadasii. Anecdotal evidence suggests that camelids are particularly susceptible to this disease and that a relatively large percentage of pneumonias in these animals are caused by Coccidioides spp. In a search of 21 y (1992-2013) of records from the California Animal Health and Food Safety Laboratory, we found 79 cases of coccidioidomycosis diagnosed in camelids; 66 (84%) had pneumonia and 13 (16%) had lesions only in organs other than the lungs. The organs most frequently affected were lung (84%) and liver (78%). Coccidioides spp. were the cause of pneumonia in 66 of 362 (18%) camelid cases during the study period. The lesions in affected organs were multifocal-to-coalescing pyogranulomas, which in most cases were visible grossly. Ten of the 12 formalin-fixed, paraffin-embedded lung samples tested by a universal Coccidioides spp. PCR assay were positive (4 C. immitis, 2 C. posadasii); the species could not be determined in 4 of the 10 cases positive by PCR. Coccidioidomycosis is an important cause of pneumonia in camelids in California, and can be caused by either C. immitis or C. posadasii.
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Affiliation(s)
- Julian A Fernandez
- Basic and Agricultural Studies Department, Veterinary School, National University of Rio Cuarto, Rio Cuarto, Argentina (Fernandez).,Pathology Department, Veterinary School, Autonomous University of Barcelona, Barcelona, Spain (Hidalgo).,Real-time PCR Research and Diagnostics Core Facility (Hodzic), School of Veterinary Medicine, University of California, Davis, CA.,California Animal Health and Food Safety Laboratory, Davis (Diab), School of Veterinary Medicine, University of California, Davis, CA.,San Bernardino (Uzal) branches, School of Veterinary Medicine, University of California, Davis, CA
| | - Mireia N Hidalgo
- Basic and Agricultural Studies Department, Veterinary School, National University of Rio Cuarto, Rio Cuarto, Argentina (Fernandez).,Pathology Department, Veterinary School, Autonomous University of Barcelona, Barcelona, Spain (Hidalgo).,Real-time PCR Research and Diagnostics Core Facility (Hodzic), School of Veterinary Medicine, University of California, Davis, CA.,California Animal Health and Food Safety Laboratory, Davis (Diab), School of Veterinary Medicine, University of California, Davis, CA.,San Bernardino (Uzal) branches, School of Veterinary Medicine, University of California, Davis, CA
| | - Emir Hodzic
- Basic and Agricultural Studies Department, Veterinary School, National University of Rio Cuarto, Rio Cuarto, Argentina (Fernandez).,Pathology Department, Veterinary School, Autonomous University of Barcelona, Barcelona, Spain (Hidalgo).,Real-time PCR Research and Diagnostics Core Facility (Hodzic), School of Veterinary Medicine, University of California, Davis, CA.,California Animal Health and Food Safety Laboratory, Davis (Diab), School of Veterinary Medicine, University of California, Davis, CA.,San Bernardino (Uzal) branches, School of Veterinary Medicine, University of California, Davis, CA
| | - Santiago S Diab
- Basic and Agricultural Studies Department, Veterinary School, National University of Rio Cuarto, Rio Cuarto, Argentina (Fernandez).,Pathology Department, Veterinary School, Autonomous University of Barcelona, Barcelona, Spain (Hidalgo).,Real-time PCR Research and Diagnostics Core Facility (Hodzic), School of Veterinary Medicine, University of California, Davis, CA.,California Animal Health and Food Safety Laboratory, Davis (Diab), School of Veterinary Medicine, University of California, Davis, CA.,San Bernardino (Uzal) branches, School of Veterinary Medicine, University of California, Davis, CA
| | - Francisco A Uzal
- Basic and Agricultural Studies Department, Veterinary School, National University of Rio Cuarto, Rio Cuarto, Argentina (Fernandez).,Pathology Department, Veterinary School, Autonomous University of Barcelona, Barcelona, Spain (Hidalgo).,Real-time PCR Research and Diagnostics Core Facility (Hodzic), School of Veterinary Medicine, University of California, Davis, CA.,California Animal Health and Food Safety Laboratory, Davis (Diab), School of Veterinary Medicine, University of California, Davis, CA.,San Bernardino (Uzal) branches, School of Veterinary Medicine, University of California, Davis, CA
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18
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Wiederhold NP, Shubitz LF, Najvar LK, Jaramillo R, Olivo M, Catano G, Trinh HT, Yates CM, Schotzinger RJ, Garvey EP, Patterson TF. The Novel Fungal Cyp51 Inhibitor VT-1598 Is Efficacious in Experimental Models of Central Nervous System Coccidioidomycosis Caused by Coccidioides posadasii and Coccidioides immitis. Antimicrob Agents Chemother 2018; 62:e02258-17. [PMID: 29437615 DOI: 10.1128/AAC.02258-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/29/2018] [Indexed: 01/26/2023] Open
Abstract
Coccidioidal meningitis can cause significant morbidity, and lifelong antifungal therapy is often required. VT-1598 is a fungus-specific Cyp51 inhibitor that has potent in vitro activity against Coccidioides species. We evaluated the in vivo efficacy of VT-1598 in murine models of central nervous system coccidioidomycosis caused by C. posadasii and C. immitis Infection was introduced via intracranial inoculation, and therapy began 48 h postinoculation. Oral treatments consisted of vehicle control, VT-1598, and positive controls of fluconazole in the C. immitis study and VT-1161 in the C. posadasii study. Treatment continued for 7 and 14 days in the fungal-burden and survival studies, respectively. Fungal burden was assessed in brain tissue collected 24 to 48 h posttreatment in the fungal-burden studies, on the days the mice succumbed to infection, or at prespecified endpoints in the survival studies. VT-1598 plasma concentrations were also measured in the C. posadasii study. VT-1598 resulted in significant improvements in survival in mice infected with either species. In addition, the fungal burden was significantly reduced in the fungal-burden studies. Plasma concentrations 48 h after dosing stopped remained above the VT-1598 MIC against the C. posadasii isolate, although levels were undetectable in the survival study after a 4-week washout. Whereas fungal burden remained suppressed after a 2-week washout in the C. immitis model, a higher fungal burden was observed in the survival arm of the C. posadasii model. This in vivo efficacy supports human studies to establish the utility of VT-1598 for the treatment of coccidioidomycosis.
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19
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Mehrkens LR, Mohr FC, Sykes JE. Clinicopathologic and Histopathologic Renal Abnormalities in Dogs with Coccidioidomycosis. J Vet Intern Med 2018; 30:1667-1671. [PMID: 27717191 PMCID: PMC5032887 DOI: 10.1111/jvim.14573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/08/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background We observed evidence of protein‐losing nephropathy in some dogs with coccidioidomycosis, suggestive of immune complex glomerulonephritis (ICGN). The goal of this study was to understand the prevalence of renal histopathologic lesions and proteinuria in dogs with coccidioidomycosis. Hypothesis Biochemical and histopathological evidence of glomerular lesions is present in dogs with coccidioidomycosis. Animals Hundred and fifty‐six dogs with naturally occurring coccidioidomycosis. Methods Retrospective case series. Clinical information and results of clinicopathologic testing were retrieved from the University of California, Davis Veterinary Medical Teaching Hospital (VMTH). Microscopic sections of renal tissue procured from necropsy of dogs with coccidioidomycosis were examined to evaluate the nature and distribution of lesions. Results A total of 156 dogs with coccidioidomycosis were identified; 87 dogs had serum biochemistry and a urinalysis performed, 17 had urine protein:creatinine ratios (UPCs), and 24 had renal tissue available for histopathology. Eleven (13%) of the 87 dogs were azotemic, 55 (63%) were proteinuric (of which 14 [25%] had clinically relevant proteinuria defined as ≥3+ or ≥500 mg/dL), and 14 dogs had UPC ≥0.5 (range, 0.5–21.5, median 4.2). Thirteen (54%) of 24 dogs had renal histopathologic lesions suggestive of ICGN. Seven of these dogs had urinalyses performed; 5 (71%) had clinically relevant proteinuria as described above. Two dogs (33%) with normal glomeruli had granulomatous nephritis, 1 of which had intralesional Coccidioides spherules. Conclusions and Clinical Importance Coccidioidomycosis should be considered as a possible contributor to glomerular disease in dogs. Whether similar lesions occur in other mammalian hosts, including humans, warrants further investigation.
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Affiliation(s)
- L R Mehrkens
- Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA
| | - F C Mohr
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA
| | - J E Sykes
- The Department of Medicine & Epidemiology, University of California, Davis, Davis, CA.
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20
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Abstract
Although Coccidioides genotypes are highly genetically variable,
they cluster into discrete populations, which has implications for human
infections. During the past 20 years, a general picture of the genetic diversity and population
structure of Coccidioides, the causal agent of coccidioidomycosis
(Valley fever), has emerged. The genus consists of 2 genetically diverse species,
C. immitis and C. posadasii, each of which
contains 1 or more distinct populations with limited gene flow. Genotypic data
indicate that C. immitis is divided into 2 subpopulations (central
and southern California populations) and C. posadasii is divided
into 3 subpopulations (Arizona, Mexico, and Texas/South America populations).
However, admixture within and among these populations and the current paucity of
environmental isolates limit our understanding of the population genetics of
Coccidioides. We assessed population structure of
Coccidioides in Arizona by analyzing 495 clinical and
environmental isolates. Our findings confirm the population structure as previously
described and indicate a finer scale population structure in Arizona. Environmental
isolates appear to have higher genetic diversity than isolates from human
patients.
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21
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Brennan-Krohn T, Yoon E, Nishino M, Kirby JE, Riedel S. Arthroconidia in lung tissue: an unusual histopathological finding in pulmonary coccidioidomycosis. Hum Pathol 2018; 71:55-59. [PMID: 28778515 PMCID: PMC5936468 DOI: 10.1016/j.humpath.2017.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/17/2017] [Indexed: 01/21/2023]
Abstract
Coccidioides immitis/posadasii presents in mycelial form with branching hyphae and arthroconidia when cultured in the laboratory. On histopathology, the presence of endospore-containing spherules is considered diagnostic of coccidioidomycosis. Here we report an unusual case of coccidioidomycosis with hyphae and arthroconidia in pulmonary tissue sections. A 49-year-old male patient with intermittently treated pulmonary coccidioidomycosis sought treatment for residual pulmonary complaints. A cavity in the left upper lobe was seen on computed tomographic scan. Due to minimal improvement of symptoms despite treatment with fluconazole, a left upper lobectomy was ultimately performed. Coccidioides mimmitis/posadasii was identified by culture and DNA probe from the lobectomy specimen. The histopathology showed a fibro-cavitary lesion, with arthroconidia and hyphal structures, but no typical endospore-forming spherules. While uncommon, C. immitis/posadasii may present with hyphae and arthroconidia on histopathology. Pathologists should be aware of this unusual presentation; culture remains the most reliable method for definitive diagnosis.
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Affiliation(s)
- Thea Brennan-Krohn
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Boston Children's Hospital, Division of Infectious Diseases, Boston, MA, 02215
| | - Edward Yoon
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215
| | - Michiya Nishino
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Harvard Medical School, Boston, MA 02215
| | - James E Kirby
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Harvard Medical School, Boston, MA 02215
| | - Stefan Riedel
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Harvard Medical School, Boston, MA 02215.
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22
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McConnell MF, Shi A, Lasco TM, Yoon L. Disseminated coccidioidomycosis with multifocal musculoskeletal disease involvement. Radiol Case Rep 2017; 12:141-5. [PMID: 28228898 DOI: 10.1016/j.radcr.2016.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
We report a rare case of disseminated coccidioidomycosis with multifocal musculoskeletal involvement. The patient presented to the emergency department with left shoulder pain and swelling. Magnetic resonance imaging of the left shoulder revealed enhancing soft tissue masses, bony lesions, and fluid collections in and around the glenohumeral joint with involvement of the proximal humerus, glenoid, and rotator cuff musculature. Multiple additional areas of involvement were subsequently discovered. Fungal cultures confirmed coccidioidomycosis infection at all surgical sites with superimposed polymicrobial bacterial infection in the left shoulder.
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23
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Kirkland TN. The Quest for a Vaccine Against Coccidioidomycosis: A Neglected Disease of the Americas. J Fungi (Basel) 2016; 2:E34. [PMID: 29376949 PMCID: PMC5715932 DOI: 10.3390/jof2040034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 12/04/2022] Open
Abstract
Coccidioidomycosis (Valley Fever) is a disease caused by inhalation of Coccidioides spp. This neglected disease has substantial public health impact despite its geographic restriction to desert areas of the southwestern U.S., Mexico, Central and South America. The incidence of this infection in California and Arizona has been increasing over the past fifteen years. Several large cities are within the endemic region in the U.S. Coccidioidomycosis accounts for 25,000 hospital admissions per year in California. While most cases of coccidioidomycosis resolve spontaneously, up to 40% are severe enough to require anti-fungal treatment, and a significant number disseminate beyond the lungs. Disseminated infection involving the meninges is fatal without appropriate treatment. Infection with Coccidioides spp. is protective against a second infection, so vaccination seems biologically plausible. This review of efforts to develop a vaccine against coccidioidomycosis focuses on vaccine approaches and the difficulties in identifying protein antigen/adjuvant combinations that protect in experimental mouse models. Although the quest for a vaccine is still in the early stage, scientific efforts for vaccine development may pave the way for future success.
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Affiliation(s)
- Theo N Kirkland
- Departments of Pathology and Medicine, University of California, San Diego, School of Medicine, San Diego, CA 92161, USA.
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24
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Oliw EH, Aragó M, Chen Y, Jernerén F. A new class of fatty acid allene oxide formed by the DOX-P450 fusion proteins of human and plant pathogenic fungi, C. immitis and Z. tritici. J Lipid Res 2016; 57:1518-28. [PMID: 27282156 DOI: 10.1194/jlr.m068981] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Indexed: 01/14/2023] Open
Abstract
Linoleate dioxygenase-cytochrome P450 (DOX-CYP) fusion enzymes are common in pathogenic fungi. The DOX domains form hydroperoxy metabolites of 18:2n-6, which can be transformed by the CYP domains to 1,2- or 1,4-diols, epoxy alcohols, or to allene oxides. We have characterized two novel allene oxide synthases (AOSs), namely, recombinant 8R-DOX-AOS of Coccidioides immitis (causing valley fever) and 8S-DOX-AOS of Zymoseptoria tritici (causing septoria tritici blotch of wheat). The 8R-DOX-AOS oxidized 18:2n-6 sequentially to 8R-hydroperoxy-9Z,12Z-octadecadienoic acid (8R-HPODE) and to an allene oxide, 8R(9)-epoxy-9,12Z-octadecadienoic acid, as judged from the accumulation of the α-ketol, 8S-hydroxy-9-oxo-12Z-octadecenoic acid. The 8S-DOX-AOS of Z. tritici transformed 18:2n-6 sequentially to 8S-HPODE and to an α-ketol, 8R-hydroxy-9-oxo-12Z-octadecenoic acid, likely formed by hydrolysis of 8S(9)-epoxy-9,12Z-octadecadienoic acid. The 8S-DOX-AOS oxidized [8R-(2)H]18:2n-6 to 8S-HPODE with retention of the (2)H-label, suggesting suprafacial hydrogen abstraction and oxygenation in contrast to 8R-DOX-AOS. Both enzymes oxidized 18:1n-9 and 18:3n-3 to α-ketols, but the catalysis of the 8R- and 8S-AOS domains differed. 8R-DOX-AOS transformed 9R-HPODE to epoxy alcohols, but 8S-DOX-AOS converted 9S-HPODE to an α-ketol (9-hydroxy-10-oxo-12Z-octadecenoic acid) and epoxy alcohols in a ratio of ∼1:2. Whereas all fatty acid allene oxides described so far have a conjugated diene impinging on the epoxide, the allene oxides formed by 8-DOX-AOS are unconjugated.
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Affiliation(s)
- Ernst H Oliw
- Division of Biochemical Pharmacology, Department of Pharmaceutical Biosciences, Uppsala University, SE-751 24 Uppsala, Sweden
| | - Marc Aragó
- Division of Biochemical Pharmacology, Department of Pharmaceutical Biosciences, Uppsala University, SE-751 24 Uppsala, Sweden
| | - Yang Chen
- Division of Biochemical Pharmacology, Department of Pharmaceutical Biosciences, Uppsala University, SE-751 24 Uppsala, Sweden
| | - Fredrik Jernerén
- Division of Biochemical Pharmacology, Department of Pharmaceutical Biosciences, Uppsala University, SE-751 24 Uppsala, Sweden
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25
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Abstract
The lack of published data on effective disinfectants and contact times for use on the fungal pathogens Coccidioides immitis and C. posadasii prompted the authors to investigate the fungicidal activity of three commonly used laboratory disinfectants on arthroconidia harvested from C. immitis strain 2009. They tested the ability of 10% bleach, 70% ethanol, and Vesphene® IIse to inactivate 107 arthroconidia in an aqueous suspension within 1, 2, 5, 10, or 20 minutes of contact time. Both 10% bleach and 70% ethanol provided a 7-log10 reduction in arthroconidia in less than 1 minute, with no growth observed at any of the tested time points. Vesphene® IIse was less effective, providing a 6-log10 reduction in arthroconidia after 5 minutes, but was unable to completely inactivate all of the arthroconidia, even after 20 minutes of contact time.
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Affiliation(s)
| | | | | | - Paul Keim
- Northern Arizona University, Flagstaff, Arizona
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Abstract
Coccidioidomycosis osteomyelitis is a rare entity considered even more rare when identified in the immunocompetent patient. In non-endemic areas, the diagnosis of a fungus-causing osteomyelitis is often delayed or overlooked. This results in delayed or inappropriate treatment. We present the case of a 35-year-old immunocompetent male immigrant from India who was ultimately diagnosed as having Coccidioidomycosis immitis osteomyelitis of his ring finger metacarpal. His initial surgery included drainage and bacterial cultures only. When he failed to improve, he presented for a second opinion. The patient's origin and travel history coupled with the appearance of rapid bone destruction on plain radiographs prompted a second operation for tissue biopsy and culture for bacteria, fungus, and mycobacteria cultures. This case highlights the importance of a thorough clinical history in deriving an appropriate differential diagnosis prior to surgical intervention.
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Affiliation(s)
- Jens U. Berli
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
| | - Wayne N. Campbell
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
| | - Ryan D. Katz
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218 USA
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27
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Canteros CE, Vélez H A, Toranzo AI, Suárez-Alvarez R, Tobón O Á, Jimenez A MDP, Restrepo M Á. Molecular identification of Coccidioides immitis in formalin-fixed, paraffin-embedded (FFPE) tissues from a Colombian patient. Med Mycol 2015; 53:520-7. [PMID: 25908652 DOI: 10.1093/mmy/myv019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/10/2015] [Indexed: 11/14/2022] Open
Abstract
Coccidioides immitis and C. posadasii are the etiologic agents of coccidioidomycosis, an endemic fungal disease of the Americas. In Colombia, this mycosis is uncommon, and only five cases, two of them imported, have been documented.By means of DNA sequencing, C. immitis was identified in formalin-fixed, paraffin-embedded archival tissues samples from the 5th Colombian patient diagnosed in 1997. The patient was born in Pinto, Department of Magdalena, and had never visited other geographic regions, a reason to consider that the mycosis had been acquired locally.This species is primarily found in California although it has been occasionally reported in other geographic areas such as Mexico and Brazil. This is the first indigenous report of C. immitis-associated coccidioidomycosis in a Colombian patient.
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Affiliation(s)
- Cristina E Canteros
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Alejandro Vélez H
- Departamento de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia Laboratorios Dinámica, Institución Prestadora de Servicios (IPS), Medellín, Colombia Universidad Pontificia Bolivariana, Escuela de Ciencias de la Salud, Medellín, Colombia
| | - Adriana I Toranzo
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Roberto Suárez-Alvarez
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Ángela Tobón O
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia Hospital La María, Medellín, Colombia
| | - María del Pilar Jimenez A
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Ángela Restrepo M
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
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28
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Johnson SM, Carlson EL, Fisher FS, Pappagianis D. Demonstration of Coccidioides immitis and Coccidioides posadasii DNA in soil samples collected from Dinosaur National Monument, Utah. Med Mycol 2014; 52:610-7. [PMID: 24847036 DOI: 10.1093/mmy/myu004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Soil samples were collected in 2006 from Dinosaur National Monument (DNM), Utah, the site of an outbreak of coccidioidomycosis in 2001. DNA was isolated from two soil samples, and polymerase chain reaction (PCR) amplified Coccidioides DNA present in both samples. Ribosomal RNA genes and internal transcribed spacer (ITS) region PCR products were sequenced. Single-nucleotide polymorphisms indicated that the DNA from sample SS06RH was that of Coccidioides immitis, while the DNA from sample SS06UM was C. posadasii. This is the first report to directly demonstrate Coccidioides in soils from DNM and the first to report the presence of both C. immitis and C. posadasii in the same geographic location.
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Affiliation(s)
- Suzanne M Johnson
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California
| | - Erin L Carlson
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California
| | | | - Demosthenes Pappagianis
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California
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