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Volume 23, Number 2—February 2017

CME ACTIVITY - Dispatch

Risk Factors for Disseminated Coccidioidomycosis, United States

Camila D. Odio1, Beatriz E. Marciano, John N. Galgiani, and Steven M. HollandComments to Author 
Author affiliations: National Institutes of Health, Bethesda, Maryland, USA (C.D. Odio, B.E. Marciano, S.M. Holland); University of Arizona College of Medicine, Tucson, Arizona, USA (J.N. Galgiani)

Main Article

Table 2

Patients with disseminated coccidioidomycosis and discrete primary immune deficiencies*

Patient no. (ref)
Age, y/sex
Race/
ethnicity
Medical history
Extrapulmonary disease
Relapse
Method of diagnosis
Genetic findings
1
4/F
White
HIES, recurrent pneumonia and otitis, skin infections, eczema, thrush
Meningitis
No
BAL/CSF cultures
STAT3: heterozygous (c.2137G>A)
2 (9)
17/F
Not reported
HIES, Staphylococcus. aureus skin and soft tissue infections, recurrent sinus infections, pneumonia
Meningitis, cerebral abscess
No
Coccidioides Ab, CSF culture
STAT3: heterozygous (p.T412S)
3 (10)
11/M
White
11 mo: Mycobacterium chelonei pneumonia 22 y; disseminated M. kansasii
Osteomyelits, lymphadenitis
Yes
Coccidioides Ab level, lymph node biopsy
IFN-γR1: deficiency (c.818del4fs)
4 (11)†
22/F
Palestinian
11 y: Salmonella serogroup D lymphadenitis
Diffuse lymphadenitis
Yes
Coccidioides IgM and IgG, lymph node biopsy
IL-12Rβ1: homozygous (p.C186Y)
5 (11)
6/M
Palestinian
No other significant history
Osteomyelitis, lymphadenitis, nasal lesion,
Yes
Lymph node, nasal lesion, bone biopsies
IL-12Rβ1: homozygous (p.C186Y)
6
15/M
Black
No other significant history
Osteomyelitis, soft tissue
Yes
BAL cultures, bone and soft biopsies
IL-12Rβ2: heterozygous (p.C101Y)
7 (12)
17/F
Hispanic
14 y: extensive, persistent tinea capitis and kerion caused by Trichophyton tonsurans
Osteomyelitis, soft tissue, cutaneous lesions
Yes
Coccidioides Ab, skin biopsy
STAT1: gain of function mutation
(p.E353K)
8 (12) 9.5/F White No other significant history Osteomyelitis, cerebral lesions, intrathoracic lymphadenitis Yes Coccidioides Ab STAT1: gain of function mutation (p.A267V)

*Ab, antibody; BAL, bronchoalveolar lavage; CSF, cerebrospinal fluid; HIES, hyperimmunoglobulin E (Job’s) syndrome; ref, reference.
†Patients 4 and 5 are siblings, and their parents are first cousins.

Main Article

1Current affiliation: Yale–New Haven Hospital, New Haven, Connecticut, USA.

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