Lecture 20: Coccidiomycosis “Valley Fever”

Question 1

What is life cycle of coccidiodes spp

Answer 1

1. Hyphae fragment into arthroconidia
2. Arthroconidia are inhaled and form spherules in lower airways
3. Spherules rupture and release endoscopes which form new spherules

Question 2

coccidiodes are dimorphic fungi, exist in soil as __ and within host convert to __

Answer 2

hyphae, yeasts

Question 3

primary route of infection of coccidiodes is through __

Answer 3

inhalation

Question 4

t or f: coccidiodes spp can spread from host to host

Answer 4

false!

Question 5

What are risk factors for dogs getting coccidiodes

Answer 5

1. Digging behavior
2. Roaming
3. Lives outside during daytime
4. Walks in the desert

Question 6

t or f: majority of coccidiodes infections are Subclinical

Answer 6

true

Question 7

what are the 2 types of clinical cases of coccidiodes

Answer 7

1. Pulmonary
2. Disseminated

Question 8

what are the signs in dogs with pulmonary coccidiodes infection

Answer 8

1. Cough (most common)
2. Decreased appetite
3. Lethargy
4. Diarrhea
5. Vomiting
6. Weight loss
7. Wheeze
8. Increased breathing effort, tachypnea
9. Reduced exercise tolerance

Question 9

what are some signs of pulmonary cocciodes in cats

Answer 9

1. Decreased appetite
   2, weight loss
2. Cough
3. respiratory distress

Question 10

dogs or cats: respiratory distress is more common with pulmonary coccidiodomycosis

Answer 10

cats

Question 11

What findings are PE are consistent with pulmonary coccidiodes

Answer 11

1. Fever (not always)
2. Increased breathing sounds, crackles, wheezes
   3 dehydration
3. Underweight (low BCS)

Question 12

what is seen on thoracic radiographs in coccidiodes

Answer 12

1. Bronchial or interstitial patterns
2. Tracheobronchial lymphandeopathy

Question 13

dog presents with chronic coughing, take thoracic rads and see this what likely cause

Answer 13

coccidiodes

Question 14

What would you expect to see on CBC/chem in patient with suspected valley fever

Answer 14

evidence of inflammation- leukocytosis, monocytosis, hperglobulinemia

Question 15

what could you see on UA in patient with valley fever

Answer 15

proteinuria

Question 16

what test is typically used to dx valley fever

Answer 16

anti-coccidiodes antibody (AGID)

Question 17

AGID IgG > or =___ in cases of suspicious pulmonary coccidiodes is convincing

Answer 17

1:16

Question 18

what is tx for valley fever

Answer 18

1. Fluconazole
2. Itraconazole
3. Terbinafine (never alone)
4. +/- prednisone

Question 19

t or f: compounding azole medications is best way to tx systemic fungal infections

Answer 19

false!

Question 20

How often should you recheck patient with valley fever

Answer 20

every 3 months

Question 21

what should you recheck q3 months in patients with valley fever

Answer 21

1. CBC/chem, UA
   - at minimum liver chemistry- anti fungal are hepatotoxic
2. Antibody serology
3. Thoracic radiographs

Question 22

what are the 3 criteria for remission in valley fever

Answer 22

1. 100% asymptomatic
2. Unremarkable thoracic radiographs or without big changes
3. Negative IgM and IgG < or = 1:8

Question 23

what should be included for emergency tx of valley fever

Answer 23

1. Supplemental oxygen
2. Amphotericin B

Question 24

what can be used to tx valley fever in refractory patients

Answer 24

1. Voriconazole (avoid in cats)
2. Posaconazole
3. +/- amphotericin B

Question 25

define disseminated coccidiodes

Answer 25

spread of infection outside lungs and intrathoracic LN

Question 26

what are some common sites for coccidiodes to disseminate to in dogs

Answer 26

bone, skin, LN, CNS, pericardium

Question 27

what are some common sites for coccidiodes to disseminate in cats

Answer 27

skin, bone, LN, CNS

Question 28

what are some signs of valley fever spreading to bone

Answer 28

pain localizable to site, lameness or discomfort

Question 29

what bones are most common for coccidiodes to disseminate to

Answer 29

appendicular bones

Question 30

what are some signs of coccidiodes that spread to skin

Answer 30

dermal or SQ nodules or non-healing draining tract lesions

Question 31

what are some signs of coccidiodes that spread to CNS

Answer 31

seizures, vestibular signs, paresis, severe mentation changes

Question 32

what are some signs of coccidiodes that spread to pericardium

Answer 32

right sided CHF, restrictive pericarditis, pericardial effusion , ascites, +/- pleural effusion

Question 33

What is ideal dx of valley fever

Answer 33

histopath, cytology, fungal cultures

Question 34

what would been seen on cytology that is consistent with valley fever

Answer 34

pyogranulomatous inflammation with no organisms

Question 35

If you obtain radiograph and 2 ddx are fungal osteomyelitis vs neoplasia what is next step

Answer 35

1. FNA 2. Bone biopsy 3. EIA antigen test or IgM and/or IgG

Question 36

what is best anti fungal to tx valley fever if CNS or eyes involved

Answer 36

fluconazole

Question 37

what defines remission from disseminated valley fever

Answer 37

1. Minimum 12 months therapy 2. 100% resolution of symptoms 3. Resolution of imaging abnormalities 4. Negative IgM and negative to low IgG titers (< or = 1:8)