COCCIDIOIDOSIS (coccidioidosis; synonym: the granuloma is koktsidioidny, a coccidioidomycosis, Posada — Vernike a disease, desert rheumatism, the Californian fever) — the deep mycosis caused by the fungus of Coccidioides immitis affecting internals, bones, skin and hypodermic cellulose.
The first descriptions of a disease, a cut mistakenly it was accepted for a new growth, belong to Posada and Vernike (A. Posada, R. J. Wernicke, 1892).
Geographical distribution and epidemiology
Mycosis is endemic for the USA (South California, Arizona, New Mexico, Texas), Mexico, Argentina, Paraguay, Venezuela and other countries of Central and South America. Isolated cases To. are described in Europe at people, zones, earlier visited in endemic for this disease. In the USSR of endemic zones K. it is not revealed.
The disease is widespread in districts of deserts and semi-deserts (dry summer and rainy winter). In wet conditions the fungus vegetirut in the soil, in droughty time its artrospor are carried by wind. The main way of infection To. — air and dust though implementation of the activator through skin, mucous membranes and intestines is possible. To. also wildings, including rodents are ill also house.
People, patients To., do not constitute danger to people around, but the used dressing material (after processing of the opened infiltrates) is subject to careful disinfection and burning.
the Infestant — Coccidioides immitis Rixford, Gilchrist, 1896 — a dimorphous fungus. In fabric represents spherical shape of education (sferula) from 10 to 120 microns and more. Inside sferul there is a large number of the endospores reaching in dia. 2 — 3 microns.
During the maturing of endospores of a cover sferul collapse, and disputes of a fungus, getting to surrounding fabric, turn into sferula. On Saburo's circle at t ° 25 — 30 ° growth of colonies of a fungus begins 3 — 4 days later after crops in the form of a wet disk of gray color which becomes covered by the short air mycelium changing the coloring from white till brown color later. Microscopically the septirovanny mycelium which later is breaking up to artrospor of a rectangular or barrel-shaped form is found. During the drying of colonies artrospor are transferred by flows of air that constitutes big danger to people around (see. Fungi parasitic, table. ).
the Pathogeny is studied insufficiently. The period of an incubation at ingalyatorny implementation an artrospor fluctuates ranging from 7 up to 18 days, and at infection through the injured skin up to 40 days. The fungus can extend gematogenno and limfogenno; it caused the secondary disseminated forms.
After the postponed disease develops immunity to repeated infection and the expressed allergy, edges comes to light skin tests on koktsidioidin; he is trained at the same time from different strains of S. of immitis which are grown up on fluid mediums within several months at t ° 37 °.
Patol, changes of fabrics at To. are not specific and diverse. The importance for gistol, diagnoses has detection in the drugs painted on Hochkissa — Mac-Manuva or Shabadash characteristic of the correct rounded shape and different in the sizes sferul with endospores in them. At a gap sferul endospores get to surrounding fabric, causing active reaction of segmentoyaderny leukocytes. Around endospores which gradually ripen histiocytes, macrophages and colossal cells accumulate. In the struck bodies against the background of growth of cicatricial fabric abscesses around which lymphocytes, plasmatic, epithelial and colossal cells like Langkhans are located are found. In lungs, e.g., defeat has character of focal consolidations of pulmonary fabric, the expressed pleurisy. Obyzvestvlyayushchiyesya the centers reach to dia. 2 — 3 cm with sites of a necrosis in the center. The centers of caseous disintegration remind tubercular cavities. In a hypodermic fatty tissue abscesses, after their opening — ulcers are formed; formation of fistulas is quite often observed.
A clinical picture
To. it is subdivided on primary (pulmonary and extra pulmonary forms) and secondary (disseminated) To., observed at 0,5% of the patients who transferred primary forms. Wedge, manifestations in most cases nepatognomonichna.
Primary pulmonary To. can proceed asymptomatically or clinically remind flu of varying severity with tendency to spontaneous treatment; however more than 1/4 patients have a cough to department of a phlegm, in a cut sferula are found. Rentgenol, data are also not specific; the localized or merging centers are found in 80% of patients in lungs, it is preferential in the lower sites of upper shares.
Primary extra pulmonary To. meets very seldom and it is shown by deep infiltrates in a hypodermic fatty tissue which ulcerate and followed limfangiity (see).
Secondary disseminated To. meningitis proceeds as acute miliary damage of lungs, acute or hron. Other internals, bones, skin are limfogenno involved in process gematogenno or.
Due to not specificity a wedge, symptoms the diagnosis is based, as a rule, on data of microscopic examinations patol, material (detection sferul), obtaining culture of the activator on Saburo's circle with a dextrose and positive takes of infection with S.'s culture of immitis of mice or Guinea pigs. Skin tests with koktsidioidiny and reaction of binding complement have indirect diagnostic value. The differential diagnosis is carried out with histoplasmosis (see), deep zymonematosis (see), sporotrichosis (see), lymphogranulomatosis (see), gummous syphilis (see), tuberculosis (see. Tuberculosis of a respiratory organs ), hron, deep pyoderma (see) and new growth.
At primary forms K. symptomatic therapy is effective. At treatment of patients disseminated To. Amphotericinum In, especially its dosage forms intended for intravenous or intraspinal (is most effective at meningitis) introductions. Are offered also derivative Amphotericinum In — amfoglyukamin and Mycoheptinum (half-yen! an antibiotic, on structure close to Amphotericinum In).
Primary pulmonary To. has tendency to spontaneous treatment, and only approximately 5% of patients have for an indefinite term centers in the form of cavities, fibrous, cicatricial changes, bronchiectasias, etc. Secondary disseminated To. proceeds hard and often comes to an end with death.
Measures of mass prevention To. are not developed. During the work with culture immitis shall be careful by S., as with causative agents of especially dangerous infections.
Bibliogr.: See bibliogr, to St. Fungi parasitic .
N. D. Sheklakov.