Primary Cutaneous Coccidioidomycosis: An Update
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REVIEW ARTICLE
Primary Cutaneous Coccidioidomycosis: An Update Irving Llibran Reyna‑Rodríguez1 · Jorge Ocampo‑Candiani1 · Sonia Chavez‑Alvarez1
© Springer Nature Switzerland AG 2020
Abstract Coccidioidomycosis is an endemic mycosis of the southern United States, Northern Mexico, and South America. Primary cutaneous coccidioidomycosis, despite being a very rare clinical presentation, has shown an increasing incidence. An extensive literature search for cutaneous coccidioidomycosis cases was performed using the OLDMEDLINE, PubMed, Cochrane, LILACS and Google Scholar databases for studies published from January 1927 through December 21, 2019. Forty-two observational studies were included totaling 82 cases of primary cutaneous coccidioidomycosis. Narrative reviews, systematic reviews, and meta-analyses were also included. Additionally, an original case was included. Patients with primary cutaneous coccidioidomycosis share the same geographical and epidemiological characteristics as those with pulmonary or disseminated coccidioidomycosis. Most of the imported cases came from endemic areas. A large portion of cases had prior local skin trauma. Tissue culture is still the leading diagnostic method; nevertheless, molecular techniques such as polymerase chain reaction (PCR) are currently relevant to differentiate between species. First-line treatment consists of azoles; however, it has an excellent prognosis even without treatment. Primary cutaneous coccidioidomycosis should be considered a differential diagnosis of unusual infections or neoformations in any part of the body in resident populations of endemic areas or in patients with a previous history of travel to these areas.
Key Points
1 Introduction
Primary cutaneous coccidioidomycosis should be considered in the differential diagnosis of skin lesions without systemic symptoms in patients from endemic areas or with a previous history of travel to these areas.
Coccidioidomycosis, also known as San Joaquin Valley Fever (SJVF), dates to 1892 when Alejandro Posadas described a series of lesions. He considered these malignant and subsequently described the etiologic agent [1]. It is an endemic pathogenic mycosis caused by the dimorphic species Coccidioides immitis and Coccidioides posadasii. It was the first of the subcutaneous mycoses to be recognized [2]. Initially, the causative agent was thought to be a protozoan. During the following decades it was concluded that it was a dimorphic fungus thanks to the work of William Ophuls et al. [3, 4]. Its characteristic life cycle begins with a large pathogenic spherule that contains endospores formed after inhalation of arthroconidia, which are usually found in saprophytic form in the vegetation or in soil [5]. This disease affects both immunocompetent and immunosuppressed individuals, with the latter having an increased risk of infection. The clinical manifestations of coccidioidomycosis are variable; predominantly this includes lung disease, with occasional lymphatic or hematogenous spread to bone, brain, and/or sk
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