CHAPTER VII 

 INFECTIONS CAUSED BY MOLDS 



COCCIDIOIDOMYCOSIS 



(Valley Fever, Coccidioidal Granuloma) 



Coccidioidomycosis is an acute, usually mild and self-limited 

 respiratory mycosis, which in exceptional cases becomes chronic and 

 generalized; it then produces granulomatous lesions in almost any 

 organ and has a high fatality rate. 



History. The first recognized case of coccidioidomycosis was re- 

 ported by Posadas and Wernicke from the Chaco region of Argen- 

 tina. The second and third were seen in 1894 in California by Rix- 

 ford and Gilchrist.^^ * The pathogen was believed to be a protozoan, 

 and Rixford and Gilchrist, seeing a resemblance to Coccidium, fol- 

 lowed a suggestion of Stiles and named it Coccidioides immitis. Four 

 years later Ophuls and IMofiitt,^- studying the third North American 

 case, isolated the organism in culture and showed that it was a 

 fungus. Although the fungus was named under the erroneous im- 

 pression that it was a protozoan the generic name was created for it 

 and actually no protozoa have ever been placed in the genus. The 

 name is therefore valid and the disease is properly designated coc- 

 cidioidomycosis, the name given it by Dickson.^- ^ One frequently 

 hears the disease miscalled coccidiosis which is an unrelated proto- 

 zoan disease common in some animals. 



The condition was known for 40 years after its discovery as a 

 chronic, generalized, usually fatal granulomatous disease called coc- 

 cidioidal granuloma. After 1936 the investigations of Gifford " and 

 of Dickson revealed that an acute, benign, respiratory disease called 

 Valley fever or desert rheumatism was a mild form of coccidioido- 

 mycosis. The subsequent studies of Dickson, Smith, ^*' ^^' ^*' Aron- 

 son ^ and others have shown that most of the residents of an endemic 

 area react to the intradermal injection of an antigen, coccidioidin, 

 prepared from the fungus. This is interpreted to mean that the 



* In Chapter VII literature citations will be found at the end of each section. 

 Citations for this section are on page 152. 



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