Some of your patients have Valley Fever: Do you know which ones?

Transcription

1 Some of your patients have : Do you know which ones? ACP-Az Meeting, Nov 13, 2015 John N Galgiani MD University of Arizona

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3 Problem in Arizona Alone Total Infections Seek Medical Attention Diagnosed/Reported Ave. illness: 6 months 75% lost 1 month of work 40% hospitalized; cost of $100M/yr (2012 est.) Disseminated Infection Deaths 100,000-10,000-1,

4 The Corridor: 2/3 of all US disease occur here

5 From Phoenix to Tucson A third of all pneumonia is Visitors to Arizona have the same risk soon after returning home AZ tourism and Cocci risk data: ~1,300 exported clinical illnesses/year Valdivia et al, Emerg. Inf. Dis, 2006

6 This syllabus is available at htpp://

7 Primary Care of Coccidioidomycosis C onsider the diagnosis O rder the right tests C heck for risk factors C heck for complications I nitiate management

8 When to Consider Symptoms Pulmonary Cough Chest pain Dyspnea Hemoptysis Arthralgias/Myalgias Headache (20%) Systemic Fatigue Night sweats Signs Weight loss Skin rashes Maculopapular rash Erythema nodosum Erythema multiforme Pulmonary symptoms may not be prominent

9 What s causing this Pneumonia?

10 When to Look for in Arizona Patients with: Community acquired pneumonia. Rheumatism. Rashes.

11 Primary Care of Coccidioidomycosis C onsider the diagnosis O rder the right tests C heck for risk factors C heck for complications I nitiate management

12 Coccidioidomycosis is a Laboratory Diagnosis Detection of anti-coccidioidal antibodies Histologic identification of spherules Culture of Coccidioides spp. Other tests Detection of coccidioidal antigens PCR detection of coccidioidal DNA

13 Order the Right Tests Detecting Coccidioidal Antibodies If coccidioidal antibodies are detected, this is a very specific result and usually important. A negative test does not eliminate the possibility of. Repeated testing improves diagnostic sensitivity.

14 Check for Risk Factors for Coccidioidal Complications Pulmonary Diabetes mellitus Cardio-pulmonary or other co-morbidities. (Evidence: common sense ). Disseminated Infection Deficient cellular immunity Males > Females Racial background African-American Filipino Adults > Children Pregnancy

15 Check for Complications Summary Most complications are focal A careful review of systems and physical examination will usually detect or exclude the possibility of complications. If new focal findings are present, further imaging and laboratory studies can determine if they are related to infection.

16 Disseminated Coccidioidomycosis

17 Disseminated Coccidioidomycosis

18 Disseminated Coccidioidomycosis

19 Disseminated Coccidioidomycosis

20 Primary Care of Coccidioidomycosis C onsider the diagnosis O rder the right tests C heck for risk factors C heck for complications I nitiate management

21 Management Low Risk, Simple Early Infection Follow-up office visits Serial body weights Check for new symptoms or signs Repeat coccidioidal antibody testing Repeat Chest PA and Lateral X-rays

22 2005 IDSA Guidelines Treatment of Coccidioidomycosis How best to manage primary respiratory coccidioidal infections is an unsettled issue because of the lack of prospective controlled trials.

23 Primary Care of Coccidioidomycosis Compatible Symptoms Repeated evaluations Diagnostic Studies Serology or Cultures + Risk Factors Present? N Focal Signs or Symptoms? - Retest Specialty Referral and / or Treatment N Observe Start Anti-fungal?

24 Thank-you