Infectious Diseases

Answer 5 Patients with early coccidioidal infections should be treated aggressively to prevent disseminated disease. Between 50% and 60% of infections due to Coccidioides immitis are subclinical or very mild. In the general population, pulmonary or extrapulmonary complications due to this organism are uncommon. Patients who are immunosuppressed, especially those with T-cell deficiencies (eg, patients with AIDS, organ transplant recipients, patients on high-dose corticosteroids), and pregnant women are at high risk for dissemination. Treatment of early coccidioidal infections for patients without risk factors has not been proven to be beneficial. H. capsulatum and B. dermatitidis are dimorphic fungi and exist in mycelial and yeast forms. Skin disease is the most common extrapulmonary manifestation of blastomycosis, and bone involvement with resultant osteolytic lesions is common. Between 10% and 30% of cases of blastomycosis in males involve the genitourinary tract,1 and most of these patients have tender enlarged prostates with pyuria. Mediastinal fibrosis is an uncommon manifestation of histoplasmosis. Treatment for mediastinal fibrosis due to histoplasmosis involves steroids, antifungal agents, and surgery and is associated with a very poor outcome. REFERENCE 1. Mandell GL, Bennett JE, Dolin R. Principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingstone; 2005. Click here to return to the questions

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