Coccidioidomycosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]; Aditya Ganti M.B.B.S. [3]

Overview

The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are lungs, skin, bones, genitourinary system, central nervous system and other organs.^[1]^[2]^[3]^[4]

Physical Examination

Vital Signs

HEENT

Photophobia, episcleritis, conjunctivitis, scleritis

Lymph nodes

In cases with skin involvement from direct inoculation, regional lymph node enlargement may be seen.

Neck

No masses

Cardiovascular system

Regular rate and rhythm
Normal S1, S2
No murmurs, rubs, or gallops

Lungs

Findings consistent with parenchymal consolidation such as^[5]

Abdominal

Abdomen soft and non-distended with no scars or striations
No pulsatile masses or abdominal bruits auscultated
Spleen not palpable, liver not palpable

Skin

Erythema nodosum ( It presents as tender red nodules on the shins that are smooth and shiny)
Erythema multiforme( classical “target lesion” appearance, with a pink-red ring around a pale center)
Verrucous lesions with irregular border and variegated appearance

Bone and joints

Soft tissue swelling around the area of involvement and discharging sinuses might be consistent with osteomyelitis.
Arthritis can cause reproducible pain in joints.

Genitourinary system

Extremities

Ulcers that bleed on touch

Neurological

Normal examination findings are seen unless the infection is disseminated to the brain resulting in meningitis, findings of neural involvement include:

Altered level of consciousness
Nuchal rigidity
Increased intracranial pressure is a most common finding when meninges are involved.

Gallery

Erythema nodosum lesions on skin of back due to hypersensitivity to antigens of Coccidioides immitis. From Public Health Image Library (PHIL). ^[6]
Chronic lesion that had been determined to be due to a Coccidioides sp. fungal infection. From Public Health Image Library (PHIL). ^[6]
Large red spot formed at volar surface of patient’s left arm, indicating a positive result to a skin test to determine whether patient was exposed to the Coccidioides spp. fungal organism. From Public Health Image Library (PHIL). ^[6]

References

↑ Stockamp NW, Thompson GR (2016). “Coccidioidomycosis”. Infect. Dis. Clin. North Am. 30 (1): 229–46. doi:10.1016/j.idc.2015.10.008. PMID 26739609.
↑ Twarog M, Thompson GR (2015). “Coccidioidomycosis: Recent Updates”. Semin Respir Crit Care Med. 36 (5): 746–55. doi:10.1055/s-0035-1562900. PMID 26398540.
↑ DiCaudo DJ (2014). “Coccidioidomycosis”. Semin Cutan Med Surg. 33 (3): 140–5. PMID 25577855.
↑ Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS (2014). “Update on the diagnosis of pulmonary coccidioidomycosis”. Ann Am Thorac Soc. 11 (2): 243–53. doi:10.1513/AnnalsATS.201308-286FR. PMID 24575994.
↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
↑ ^6.0 ^6.1 ^6.2 “Public Health Image Library (PHIL)”.

Template:WH Template:WS

[pmid26739609-1] Stockamp NW, Thompson GR (2016). “Coccidioidomycosis”. Infect. Dis. Clin. North Am. 30 (1): 229–46. doi:10.1016/j.idc.2015.10.008. PMID 26739609.

[pmid26398540-2] Twarog M, Thompson GR (2015). “Coccidioidomycosis: Recent Updates”. Semin Respir Crit Care Med. 36 (5): 746–55. doi:10.1055/s-0035-1562900. PMID 26398540.

[pmid25577855-3] DiCaudo DJ (2014). “Coccidioidomycosis”. Semin Cutan Med Surg. 33 (3): 140–5. PMID 25577855.

[pmid24575994-4] Malo J, Luraschi-Monjagatta C, Wolk DM, Thompson R, Hage CA, Knox KS (2014). “Update on the diagnosis of pulmonary coccidioidomycosis”. Ann Am Thorac Soc. 11 (2): 243–53. doi:10.1513/AnnalsATS.201308-286FR. PMID 24575994.

[5] Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.

[PHIL-6] 6.0 ^6.1 ^6.2 “Public Health Image Library (PHIL)”.

[1]

[2]

[3]

[4]

[5]

[6]