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The Roentgen Findings in Early Coccidioidomycosis

1947; Radiological Society of North America; Volume: 48; Issue: 4 Linguagem: Inglês

10.1148/48.4.323

1527-1315

H. W. Jamison, Ray A. Carter,

Antifungal resistance and susceptibility

It seems very probable that the next few years will see a decided increase in the number of sporadic cases of coccidioidal infections reported from various sections of the United States where it is not now endemic. The unsettled socio-economic conditions of the post-war world with its accelerated rate of population migration, the anticipated increase in vacation travel to or through endemic areas, and the increasing use of the airplane and other rapid means of long distance transportation, all point to such a conclusion. It has repeatedly been shown that coccidioidomycosis may be acquired by no more exposure than that incidental to passing through an area of endemic infection. These areas include large sections of the arid Southwest, having in common long, hot, dry and dusty summers. A definite correlation has been established between the number and severity of dust storms and the incidence of coccidioidal infections in these regions (4). Newly arrived residents have been observed to be particularly susceptible to the disease. The known zones of infection are especially the great central valley of California (the San Joaquin), the whole of Arizona (but particularly the regions about Phoenix and Tucson), Southwest Nevada, and parts of New Mexico and Western Texas. The disease is acquired by inhalation of dust contaminated with chlamydospores of the fungus, Coccidioides immitis. It is presumed that the fungus grows in the soil or on vegetation in the rainy season and that the spores dry up, break off, and are scattered by the wind in the dry season. An important intermediary host may be small rodents, which have been found to show a high incidence of nodular coccidioidal lung foci (13). The incubation period averages about ten days to two weeks, sufficient time for travel, under modern conditions, from an endemic zone to any part of the country. History For the purpose of this paper, the following summary of the history of coccidioidomycosis is sufficient. Beginning with the discovery of the disease in its relatively rare disseminated form in Argentina in 1892 and in California in 1894, and the identification of the organism in 1904, there accumulated, over many years, detailed information concerning the behavior of the condition in its malignant variants. In 1935 a primary, usually spontaneously recovering, pulmonary onset was proved, having far wider incidence than the serious disseminated form (14). There followed immunological proof of a still broader subclinical involvement as evidenced by the large proportion of residents of endemic areas who were shown to react positively to coccidioidin skin tests (26). Throughout, the clarification of the roentgen manifestations of the disease naturally lagged behind that of clinical, pathological, and immunological considerations, inasmuch as the pioneering investigators were not radiologists.