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Introduction: Coccidioides immitis is a fungus that develops in endemic areas characterized by dry climates, with little rainfall and easy aerial dissemination. The most common form of infection is pulmonary coccidioidomycosis, although it is often asymptomatic. There are non-respiratory forms of this disease. Osteomyelitis is an extrapulmonary manifestation of C. immitis infection. Symptoms are usually nonspecific and radiographic findings are often confused with bone tumors. Treatment of coccidioidal osteomyelitis is often challenging. Case Presentation: We report a case of a 3-year-old preschool girl from an endemic area for coccidioidomycosis who presented with pain and swelling on her left ankle. Initially, antibiotic treatment is administered for a suspected insect bite. However, her symptoms worsened and X-rays showed a lytic-like lesión. She was admitted to the hospital for biopsy and drainage surgery. The histopathological study confirms coccidioidomycosis osteomyelitis. She was started on long-term anti-fungal treatment. At 6-month follow-up, symptoms and signs of infection have been solved and X-ray image shows evidence of bone healing. Conclusion: It is important to take into account aspects related to exposure to this fungus, such as the patient's place of residence and recent trips so that the diagnostic and therapeutic approach is appropriate. Coccidioidal osteomyelitis is an infrequent pathology, especially in patients without other comorbidities. Treatment is complex and often requires not only antifungal drugs but also surgical debridement.

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Abstract Coccidioidomycosis is caused by Coccidioides immitis and Coccidioides posadasii fungi, which are endemic in certain locations in the American continent. They produce an asymptomatic infection in the majority of the exposed population, and in a lower proportion, a self-limited influenza-like illness, pneumonia or dissemination. Skin compromise could be secondary to the infection by the fungus or by a hypersensitivity reaction to the pulmonary infection. Primary skin compromise produces a chancriform, self-limited lesion, and the dissemination to the skin commonly produces nodules and abscesses, with a tendency to form fistulas. The most common hypersensitivity reaction is erythema nodosum, which is considered a marker of good prognosis. Treatment depends on the localization of the infection, the presence of dissemination, and the clinical conditions of the patient.

Resumen La coccidioidomicosis es causada por los hongos Coccidioides immitis y Coccidioides posadasii, los cuales son endémicos en determinadas localizaciones del continente americano. Producen infección asintomática en la mayoría de expuestos y en menor proporción cuadros gripales autolimitados, neumonía o diseminación. El compromiso en piel puede ser secundario a la infección por el hongo o por una reacción de hipersensibilidad a la infección pulmonar. El compromiso primario en piel produce una lesión chancreiforme, autolimitada y la diseminación a piel produce comúnmente nódulos y abscesos, con tendencia a la fistulización. La reacción de hipersensibilidad más común es el eritema nodoso, considerándose un marcador de buen pronóstico. El tratamiento depende de la localización de la infección, la presencia de diseminación y las condiciones clínicas del paciente.

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During the past 20 years, a general picture of the genetic diversity and population structure of Coccidioides, the causal agent of coccidioidomycosis (Valley fever), has emerged. The genus consists of 2 genetically diverse species, C. immitis and C. posadasii, each of which contains 1 or more distinct populations with limited gene flow. Genotypic data indicate that C. immitis is divided into 2 subpopulations (central and southern California populations) and C. posadasii is divided into 3 subpopulations (Arizona, Mexico, and Texas/South America populations). However, admixture within and among these populations and the current paucity of environmental isolates limit our understanding of the population genetics of Coccidioides. We assessed population structure of Coccidioides in Arizona by analyzing 495 clinical and environmental isolates. Our findings confirm the population structure as previously described and indicate a finer scale population structure in Arizona. Environmental isolates appear to have higher genetic diversity than isolates from human patients.

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Coccidioides immitis and C. posadasii are the etiologic agents of coccidioidomycosis, an endemic fungal disease of the Americas. In Colombia, this mycosis is uncommon, and only five cases, two of them imported, have been documented.By means of DNA sequencing, C. immitis was identified in formalin-fixed, paraffin-embedded archival tissues samples from the 5th Colombian patient diagnosed in 1997. The patient was born in Pinto, Department of Magdalena, and had never visited other geographic regions, a reason to consider that the mycosis had been acquired locally.This species is primarily found in California although it has been occasionally reported in other geographic areas such as Mexico and Brazil. This is the first indigenous report of C. immitis-associated coccidioidomycosis in a Colombian patient.

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This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

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La coccidioidomicosis es una micosis endémica en el sudoeste de los Estados Unidos, México y ciertas áreas de centro y Sudamérica. Los agentes causales son hongos del género Coccidioides. La infección primaria, habitualmente, involucra los pulmones, ocurriendo su diseminación en menos de 1 por ciento de los casos. Si bien la enfermedad extrapulmonar, usualmente, involucra la piel, el sistema nervioso central, los huesos y las articulaciones, tiene la capacidad de infectar cualquier órgano o tejido. Presentamos un caso de coccidioidomicosis extrapulmonar en un paciente masculino, con 20 años de edad, cuyo diagnóstico se estableció en una biopsia de ganglio linfático. La historia clínica no fue relevante y la biopsia se realizó debido a los hallazgos físicos sugerentes de linfoma.

Coccidioidomycosis is a deep mycotic infection endemic in the Southwestern part of the United States and Mexico and certain areas of Central and South America. The causative agents are fungi of the genus Coccidioides. Primary infection usually involves the lungs, and dissemination occurs in less than 1 percent of cases. While the extrapulmonary disease usually involves the skin, central nervous system, bones or joints, it can involve any tissue or organ. We present a case of extrapulmonary coccidioidomycosis in a 20-year-old male, in whom the diagnosis was made by a lymph node biopsy. His past history was not significant and the biopsy was performed because the physical findings were suggestive of lymphoma.

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En Venezuela las zonas xerófilas del estado Falcón, Lara y Zulia son endémicas para Coccidioides immitis. Dentro de las micosis profundas es la menos frecuente; según Albornoz se describieron 61 casos de coccidioidomicosis hasta 1966. En zonas endémicas, la coccidioidomicosis suele ser una enfermedad oportunista frecuente en pacientes con virus de inmunodeficiencia humana (VIH). Por lo tanto, podría esperarse una alta incidencia de esta entidad en pacientes infectados con el VIH, sin embargo, hasta donde sabemos, no se ha reportado ningún caso en la literatura local. En este trabajo se describen dos casos de pacientes VIH positivos que presentaron coccidioidomicosis diseminada.

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A case of pulmonary coccidioidomycosis from the rural zone of Bertolinia, PI, is reported. The patient, a farm worker, attributed his illness to the dust inhaled while digging a water well during the dry season of the year, some weeks before the onset of the clinical manifestations. The main symptoms of the disease were severe chest pain and moderate fever. The diagnosis was made histopathologically: tissue phase fungal organisms--immature spherules and spherules with endospores--were observed in histological sections of a lung fragment obtained by open chest biopsy. This is the twelfth autochthonous case of coccidioidomycosis found so far in Brazil. All of them involved native inhabitants of the semi-arid part of Northeastern Brazil. The hot and dry environment of the region seems to favor the development of C. immitis in the soil. Humans and animals probably acquire the infection by digging the soil, when they become exposed to the conidium-bearing dust raised by this activity.

É descrito um caso de coccidioidomicose pulmonar oriundo da zona rural de Bertolínia, PI. A manifestação clínica principal consistiu em dor torácica e o diagnóstico teve por base o achado do agente ¾ Coccidioides immitis ¾ em cortes histológicos. Formas teciduais do microrganismo ¾ esférulas imaturas e maduras ¾ estavam presentes nas lesões observadas em fragmento pulmonar removido do paciente por biópsia a céu aberto. Este novo caso autóctone da doença, como os outros anteriormente descritos no Brasil, procedia do interior semi-árido da Região Nordeste. O ambiente quente e seco do sertão nordestino oferece, sem dúvida, condições propícias ao desenvolvimento de C. immitis, um habitante do solo. As pessoas e animais do local devem adquirir a infecção ao revolver a terra, ato que os expõe à poeira contendo os propágulos do fungo.

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