Coccidioidomicosis: Más que una enfermedad regional

coccidioidomycosis is a fungal disease caused by two nearly identical species, coccidioides immitis and c. posadasii. it is endemic in the semiarid zones of the western hemisphere, especially in the southern united states of america and northern mexico, although there are definite endemic regions in central and south america; occasionally, it is diagnosed outside the endemic areas. in méxico most of the reported cases come from the northern states; however, not being a reportable disease, its true incidence is unknown. more than 60 percent of the primary infections are asymptomatic; in the rest, the typical presentation includes systemic, dermatologic and respiratory signs and symptoms ("valley fever"). the acute pulmonary presentation is indistinguishable from a community acquired bacterial pneumonia. extrapulmonary coccidioidomycosis occurs in one out of 200 primary infections. the most commonly affected sites include the central nervous system, bone, joints, skin and soft tissues. diagnosis is based in the isolation of the fungus by culture; direct observation of the spherules in exudates or in tissue is also considered diagnostic. there are serologic essays available for diagnosis. coccidioidomycosis includes a wide spectrum of clinical presentations, from the primary non complicated self-limited infection that usually resolves without specific treatment, to the acute disseminated forms usually fatal despite therapy. for this reason, the therapeutic strategies vary considerably from patient to patient. the most frequently used antimycotic drugs are amphotericin b, itraconazole and fluconazole.