Coccidioidomycosis: New Aspects of Epidemiology and Therapy

Coccidioidomycosis is the oldest of the major mycoses, on the basis of reports in the literature. The first case was reported in 1892 and occurred in an Argentine soldier. Thus, last year represented the centennial of its discovery. The case was erroneously reported as that of mycosis fungoides. Soon there followed reports from San Francisco describing the disorder as a protozoan infection. It was not until the work of Ophuls in the early part of this century that the disease was properly classified as a mycosis and the causative organism identified as Coccidioides immitis. In the late 1930s, Gifford recognized that the organism that she recovered from the sputum of many patients suffering from a well-known, selflimited pulmonary infection known as San Joaquin Valley fever was the same as the agent described by Ophuls in his report of frequently fatal coccidioidal granuloma. C. E. Smith and his colleagues, under the auspices of the Armed Forces Epidemiological Board, defined the clinical syndrome of primary and disseminated coccidioidal disease during the Second World War. They outlined the area of endemicity, recognized that there were distinct racial differences in the occurrence of dissemination, and developed a series of highly sensitive and specific immunologic diagnostic tests. Their work established a scientific basis of research that, with the isolation of the antibiotic amphotericin B, led to the therapeutic era. The addition of the imidazole group of drugs to the armamentarium followed, and the introduction in the 1980s of the orally active azole derivatives opened yet another era of therapy for coccidioidomycosis.