Coccidioidomycosis in an Immunocompetent Host After Brief Exposure History
Notice bibliographique
Résumé
Abstract Coccidioidomycosis, commonly known as “Valley fever,” is caused by Coccidioides immitis or C. posadasii. Although most infections are asymptomatic or limited to mild respiratory symptoms, approximately 1% of cases disseminate to involve other organs, such as the skin, bones, and central nervous system (CNS). The risk of dissemination is higher in individuals with weakened immune systems; however, it can also occur in immunocompetent individuals. The patient is a 48-year-old male who presented with generalized weakness and shortness of breath. Symptoms have been ongoing for four weeks since being diagnosed and treated for pneumonia with oral antibiotics, without improvement. Patient continued to have nonproductive cough and shortness of breath with exertion. He was subsequently given another course of antibiotics and steroids which mildly improved symptoms. Prior to admission he started experiencing worsening weakness particularly in the lower extremities. He noted an intermittent fever, weight loss, and chills. History revealed recent travel to Canada. He denied smoking, occupational exposures, any exotic pets, and no history of lung disease or serious infections. A Computed Tomography scan of the chest was significant for scattered bilateral ground-glass and consolidative airspace opacities compatible with multifocal airspace disease, particularly with a tree in-bud pattern. Labs significant for eosinophilia. Autoimmune and infectious workup was performed, specifically for fungal organisms. Coccidioides antibody was positive. Targeted history revealed some time working in the southwest at construction sites prior to developing symptoms. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. The patient was started on fluconazole and discharged to follow up closely. Post-discharge, fungal lavage cultures grew Coccidioides posadasii. Coccidioidomycosis generally presents as a self-limited respiratory illness; however, dissemination can occur, particularly in patients with risk factors, including immunosuppression or recent exposure in endemic regions. This case highlights the potential severity of disease in previously healthy individuals following exposure to the fungus. The patient's generalized weakness, exacerbated by dehydration and hyponatremia, coupled with eosinophilia, raised concerns for possible autoimmune or hypersensitivity reactions. Fluconazole remains the first-line treatment for disseminated disease, while amphotericin B may be necessary in severe cases. The patient showed improvement with antifungal therapy, and no CNS involvement was detected. This case emphasizes the importance of considering coccidioidomycosis in patients presenting with pneumonia, particularly following travel to endemic areas. Disseminated coccidioidomycosis can occur even in immunocompetent individuals and may involve multiple systems. Early diagnosis and appropriate antifungal therapy are critical for ensuring a favorable outcome.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».