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Endemic Mycoses, Endemic Mycoses Paracoccidioidomycosis Where? Central, South America -BRAZIL, VENEZUELA, COLUMBIA -not US -Males w/ dz 9x more than women -ESTRADIOL inhibits mycelia->yeast conversion, Endemic Mycoses Coccidioidomycosis Where? -SOUTHERN CA, SAN JOAQUIN VALLEY, NM, WEST TEXAS, AZ -model airplane outbreak -archeology student outbreak -MEXICO->pennsylvania church outbreak -10mill in US active or residual infx -up to 300K new cases/yr -70 deaths/year, Endemic Mycoses Coccidioidomycosis How to Dx? -skin test-(+) in 99% pulm dz (+) in 33% of disseminated -less delayed hypersensitivity -Complement Fixation-rising->concern -falling->good prognosis, Endemic Mycoses Coccidioidomycosis How? COCCIDIOIDES IMMITIS -inhalation of arthrospores in dust -infective dose = 10 spores -dimorphic -mycelial in soil, lab media -highly infectious->WARN LAB!! -spherule phase-parasitic-in humans -non-infectious -spherules - 10-80 um -endospores - 2-5um, Endemic Mycoses Histoplasmosis How to Dx? -Complement fixation-detect ABs-late in dz ɭ:16 or 4-fold rise in tites -Immunodiffusion-detect ABs, sensitive -Urine, blood polysacch Ag detection by RIA -Direct stains of buffy coat, tissue -disseminated: Culture blood (lysis centrifugation), bone marrow, urine -1-2 wks for results -skin test-epidemiologic surveys, no Dx value -often (-) w/ dissemination, Endemic Mycoses Histoplasmosis Where?-worldwide -US: OHIO, MISSISSIPPI RIVER VALLEYS VA, MD -in soil enriched w/ chicken, bat, bird (starlings) feces, Endemic Mycoses Blastomycosis Where? OHIO, MISSISSIPPI RIVER VALLEYS MO, AK RIVER BASINS KENTUCKY, AR, MS, NC, TN, LA -Wisc, Minn, Illinois, Virginia + Franklin, VA microfocus, Endemic Mycoses Paracoccidioidomycosis How to Dx? -Serologic-yeast and mycelial Ags -reliable-EIA, CF, agar gel diffusions, Endemic Mycoses Paracoccidioidomycosis What happens? -Acute or chronic PNEUMONIA ->can disseminate-LNs, adrenal -MOST OFTEN: ORAL, NASAL, FACIAL ULCERATIVE LESIONS ->lose teeth, etc., Endemic Mycoses Blastomycosis What happens? -pulm, cutaneous (verrucous lesions), bone, GU, or CNS involvement -25-50% w/ OSTEOMYELITIS-any bone -Prostatitis, Epididymo-orchitis -5-10% w/ CNS involvement -Pulm infx-acute w/ ARDS, heavy inoc, self-limited pneumonitis, or chronic dz