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Involvement of the spleen by Coccidioides is uncommon. It is usually associated only with disseminated infection and manifests as microscopic granulomas in the spleen. We report an immunosuppressed dermatomyositis patient who presented with splenic abscesses demonstrated on a computed tomography (CT) scan which was presumed to be bacterial in origin. At splenectomy the spleen was found to be filled with aggregates of spherules due to Coccidioides. Finding large splenic abscesses on CT scan due to Coccidioides has not been previously described. We offer a hypothesis for why the abscesses occurred in this unique patient.

No abstract available. Article truncated at 150 words. In response to the paper by PR Bauer and VN Iyer (1) entitled “Corticosteroids and Influenza A Associated Acute Respiratory Distress Syndrome” published in the Southwest Journal of Pulmonary and Critical Care (SWJPCC) on November 18, 2016. That paper presents a single case report of a patient with community-acquired pneumonia in Arizona attributed to influenza A. The patient was treated with steroids and improved. For a variety of reasons, a case report like this should not be published unless accompanied by a note pointing out the implications of such a report. The audience of SWJPCC is generally going to be made up of two groups, mainly from Arizona. Those with experience who would say that the treating physicians were lucky (but in the back of their minds this case might give them a reason to use steroids in similar circumstances) and those with little or no experience, who will say …

A 25 year old diabetic woman was admitted into the Intensive Care Unit because of ketoacidosis, hypotension and upper gastrointestinal bleeding. Emergency endoscopic biopsy of the upper gastrointestinal tract demonstrated invasive, non-septate fungal hyphae suggestive of either a Zygomyces or Basidiobolus. Amphotericin B was not used because of its ineffectiveness against Basidiobolus and her renal failure. In addition, first generation antifungal azoles were not used because of their ineffectiveness against Zygomyces. The patient responded to medical therapy and the broad-spectrum azole antifungal posaconazole which has activity against both Basidiobolus and Zygomyces. The patient recovered from her critical illness and on follow up was without residual problems.

The female genital tract is rarely involved by coccidioidomycosis. We describe a woman with disseminated coccidioidomycosis involving the female pelvic organs associated with elevated tumor markers CA 125 and CA 19-9. She had no fevers and the initial clinical suspicion was a malignancy because of the elevated tumor markers. At exploratory laparotomy a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed because of the suspicion of a malignancy. Subsequent pathology demonstrated coccidioidomycosis involving the female genital tract and no malignancy. The abnormal CA 125 and CA 19-9 returned to normal after surgical resection and treatment of the coccidioidomycosis.

No abstract available. Article truncated after 150 words. This editorial is in response to the article "Common Mistakes in Managing Pulmonary Coccidioidomycosis" by Drs. Galgiani, Knox, Rundbaken and Siever (1). These authors are eminently qualified to discuss the management of pulmonary coccidioidomycosis. However, these “mistakes” have been made for many years and, truth be known, the authors probably made some of those mistakes when faced with their first patient with a serious Coccidioides infection. What obviously is missing are from these experts are solutions to keep the mistakes from happening. I would like to fill in the deficit by offering remedies for important issues raised by the article, and more. Who am I to offer solutions? I am board-certified in Infectious Diseases (therefore, qualified). I went into private practice in Phoenix 35 years ago solely doing Infectious Disease consultations. As a consequence I am pretty sure I have seen more patients with coccidioidomycosis (I can spell it 4 ...

Background: Sarcoidosis is a granulomatous disease of unknown etiology and coccidioidomycosis is a granulomatous fungal infection endemic to the southwestern United States. Clinical observations on patients with sarcoidosis and coccidioidomycosis simultaneously led to the hypothesis that sarcoidosis can be caused by the fungus Coccidioides ., Methods: Two patients with sarcoidosis and coccidioidomycosis were studied, one prospectively (ie, a patient with sarcoidosis was predicted to develop coccidioidomycosis) and the other retrospectively (ie, a patient with coccidioidomycosis develops sarcoidosis). In addition, a literature review found 5 patients with these 2 diseases, and they were analyzed to establish an archived relationship between the 2 entities. In addition, polymerase chain reaction (PCR) testing for Coccidioides deoxyribonucleic acid (DNA) was performed on tissue from 15 Arizona patients diagnosed with sarcoidosis., Results: Patient 1 was diagnosed with sarcoid in Arizona and followed prospectively. There was no evidence for coccidioidomycosis at diagnosis. This patient was observed for 8 years before he was documented to have disseminated coccidioidomycosis. Patient 2 was retrospectively studied. He was diagnosed with disseminated coccidioidomycosis, but after 3 years, while on antifungal therapy, he developed respiratory failure. A lung biopsy was consistent with sarcoidosis with no evidence of Coccidioides ; cultures, histopathology, and serology were all negative. Paradoxically, PCR testing for Coccidioides DNA on tissue taken at the time of the sarcoidosis diagnosis were all negative, including Patient 2 who had proven coccidioidomycosis., Conclusions: The 2 study patients and 5 case reports from the literature support the hypothesis that Coccidioides can cause sarcoidosis in Arizona. There are similar reports in the literature that Histoplasma can be associated with sarcoidosis. Based on these observations, we propose that sarcoidosis can be caused by endemic fungi in different areas of the United States, coccidioidomycosis in the Southwest and histoplasmosis in the Midwest.

Background: Coccidioidal meningitis (CM), a common cause of chronic meningitis in endemic area, is usually diagnosed by detection of anti-Coccidioides antibodies in cerebrospinal fluid (CSF), and findings may be negative in up to one-third of cases. CSF cultures and cytology are infrequently positive. Antigen detection has been used for the diagnosis of other forms of coccidioidomycosis and meningitis caused by other mycoses. The purpose of this study was to assess the diagnostic utility of CSF Coccidioides antigen (CAg) detection for the diagnosis of CM., Methods: The medical records of patients with clinically suspected meningitis, in whom CSF was tested for Coccidioides antibodies and CAg, were retrospectively reviewed, and CSF CAg testing was prospectively conducted in patients with CM. All specimens were submitted for CAg testing., Results: Thirty-six patients with 42 episode of CM were studied. The sensitivity and specificity of CAg were 93% and 100%, respectively. Cultures of CSF were positive in 7%, antibodies were demonstrated by immunodiffusion in 67% and complement fixation in 70%, and immunoglobulin M and G antibodies were demonstrated by enzyme immunoassay in 8% and 85%, respectively., Conclusions: Testing CSF for CAg is a useful addition to diagnostic methods in suspected CM and complements testing with CSF antibodies and culture., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The clinical observation has been made that there might be an unacceptable number of false-positive enzyme immunoassay (EIA) test results for IgM among persons suspected of having coccidioidomycosis. Patients with a positive result for IgM by EIA are thought to have a diagnosis of acute coccidioidomycosis. However, this study found that 82% of patients with an IgM-positive and IgG-negative EIA result did not have coccidioidomycosis.

Background: We have previously shown antigenuria in patients with coccidioidomycosis through use of the Histoplasma antigen enzyme immunoassay (EIA), and now we have developed a specific Coccidioides antigen EIA., Methods: The Coccidioides EIA uses antibodies to Coccidioides galactomannan. The sensitivity of the Coccidioides and Histoplasma EIAs was evaluated in patients with more-severe coccidioidomycosis, and the specificity of these EIAs was evaluated in patients with nonfungal infections, in patients with other endemic mycoses, and in healthy individuals., Results: Among patients in the present study, antigenuria was detected in 70.8% of patients with coccidioidomycosis with use of the Coccidioides EIA and in 58.3% of patients with use of the Histoplasma EIA. Antigenuria was absent in 99.4% of healthy individuals, patients with nonfungal infections, and patients with noninfectious conditions. Cross-reactions with other endemic mycoses were observed in 10.7% of patients., Conclusions: The Coccidioides EIA has potential to be useful in the rapid diagnosis of more-severe forms of coccidioidomycosis.

We report West Nile virus (WNV) RNA in urine collected from a patient with encephalitis 8 days after symptom onset. Viral RNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Sequence and phylogenetic analysis confirmed the PCR product to have > or = 99% similarity to the WNV strain NY 2000-crow3356.

The purpose of this paper is to present the genetic distribution at the HLA-A, B, C, and DR loci in the Hopi and the Navajo. A sample of 100 out-patients from each tribe was selected at the Public Health Service Indian Hospital in Keam's Canyon, Arizona, and was typed for the antigens at the four loci. The distributions of the alleles and the haplotypes are similar in each tribe. A distance measure, f, confirms the genetic similarity of the two populations. It is concluded that the great cultural diversity of the Hopi and the Navajo is the result of a cultural evolution and diversification that has greatly outstripped the genetic evolution at the major histocompatibility loci over the past 20,000 years.

Haemophilus ducreyi was isolated from a patient who presented with a genital ulcer at the Port Moresby Clinic for Sexually Transmitted Diseases. This provides documentation for the occurrence of chancroid in Papua New Guinea. The differentiation of this disease from donovanosis is discussed.

Eighteen cases of Reiter's syndrome were found in a population of approximately 6,000 Navajo Indians. The phenotype frequency of HLA-B27 in this population was found to be 36%. The area in which these people live is endemic for shigellosis, Shigella flexneri being the most common species isolated. Presumably the high frequency of HLA-B27 and shigella infections account for the high incidence and prevalence of Reiter's syndrome in this population.

The recent epidemic of cholera on the Pacific Ocean atoll of Tarawa, Gilbert Islands renewed interest in the use of coconut water as a rehydration fluid. Fifty-one samples of coconut water from Tarawa were analysed for a variety of constituents to assess its potential usefulness in the oral and parenteral rehydration of patients with cholera and other severe forms of gastroenteritis. Compared to oral rehydration fluids known to be effective in cholera, coconut water was found to have adequate potassium and glucose content, however was relatively deficient in sodium, chloride and bicarbonate. The addition of table salt to the coconut water is suggested to compensate for the sodium and chloride deficiency. In areas of the world where coconuts are plentiful, the advantages of sterility, availability and acceptability make coconut water theoretically feasible for the oral rehydration of patients with severe gastroenteritis when conventional fluids are unavailable.

"Navajo arthritis" was described in 1971 as an acute, self-limited, asymmetric polyarthritis of unknown etiology seen in Navajo Indian patients. This description was before published accounts relating HLA-B27 to certain seronegative arthropathies. Review of 92 cases of arthritis seen between 1977 through 1979 in adult Navajo Indians revealed 16 cases of complete Reiter's syndrome, 6 cases of incomplete Reiter's syndrome, and 7 cases of ankylosing spondylitis. The phenotype frequency of HLA-B27 in this Navajo population is 36% and, of the Reiter's syndrome and ankylosing spondylitis patients tested, 85% were found to be HLA-B27 positive. We suggest that "Navajo arthritis" may not be a unique form of arthritis affecting only the Navajo, but a variant of either Reiter's syndrome or ankylosing spondylitis.