Coccidioidomycosis

Japanese: コクシジオイデス症

(1) Coccidioidomycosis
It is caused by the dimorphic fungus Coccidioides immitis. It is the most contagious and dangerous of all fungi, and can easily infect healthy people. It is most prevalent in the southwestern United States (California, Arizona, etc.), but cases can also be found in various parts of Central and South America. It is the only mycosis designated under the Infectious Diseases Control Act (Class 4).
Infection occurs via inhalation of C. immitis spores (arthroconidia). The spores grow into spherules in the lungs and spread by releasing large numbers of endospores. The incubation period is 1-4 weeks. The disease can be classified into acute pulmonary coccidioidomycosis, chronic pulmonary coccidioidomycosis, and disseminated (meninges, bone, skin, etc.). Risk factors include impaired cell-mediated immunity (AIDS, steroid administration, organ transplantation, etc.), diabetes, pregnancy, and chronic obstructive pulmonary disease.
Symptoms vary depending on the disease type and pathology, but include cold-like symptoms (fever, cough, phlegm, chest pain, etc.), erythema nodosum, bloody sputum, and weight loss. Laboratory findings include general inflammatory reactions and sometimes eosinophilia. Specific antibodies in serum (or cerebrospinal fluid) are useful because of their high sensitivity and specificity. In recent years, antigen detection methods have also been developed. Chest X-rays show nodules, cavities, infiltrative shadows, pleural effusion, and diffuse granular shadows. Definitive diagnosis requires confirmation of the bacteria by culture or pathological examination, but culture is risky and should not be performed lightly. Treatment involves administration of antifungal drugs (azole drugs, amphotericin B, etc.) or resection of the affected area, depending on the disease type and severity. Prognosis is particularly poor when the infection is disseminated and spreads to important organs such as the central nervous system. [Katsuhiko Kamei]

Source : Internal Medicine, 10th Edition About Internal Medicine, 10th Edition Information

Japanese:

（1）コクシジオイデス症（coccidioidomycosis）
　二形性真菌であるCoccidioides immitisによる．真菌としては最も感染力が強く危険であり，健常者に容易に感染する．米国南西部（カリフォルニア，アリゾナなど）が中心であるが，中南米各地にも症例がみられる．真菌症のなかで唯一，感染症法（四類）で指定されている．
　感染はC. immitisの胞子（分節型分生子）の吸入による．胞子は肺で球状体へと成長し，大量の内生胞子を放出して広がっていく．潜伏期は1～4週間である．病型には，急性肺コクシジオイデス症，慢性肺コクシジオイデス症，播種性（髄膜，骨，皮膚など）などがある．危険因子としては，細胞性免疫障害（AIDS，ステロイド投与，臓器移植など），糖尿病，妊娠，慢性閉塞性肺疾患などがある．
　症状は病型，病態により多彩であるが，感冒様症状（発熱，咳，痰，胸痛など），結節性紅斑，血痰，体重減少などがみられる．検査所見では，一般的な炎症反応に加え，ときに好酸球増加がみられる．血清（あるいは髄液）の特異抗体は，感度，特異度とも高く有用である．近年，抗原検出法も開発された．胸部X線写真では，結節，空洞，浸潤影，胸水，びまん性粒状影などがみられる．確定診断には培養あるいは病理検査による菌の確認が必要であるが，培養には危険が伴うので安易に行うべきではない．治療は，病型，重症度に応じて，抗真菌薬（アゾール薬，アムホテリシンBなど）の投与，あるいは病変部の切除を行う．播種性で中枢神経系などの重要臓器に感染が拡大した場合は，特に予後不良である．［亀井克彦］

出典　内科学第10版内科学第10版について　情報

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