Coccidioidomycosis Joint Pain

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis spores. Mild cases of this condition are uncommon and treatment is typically not needed. However, this disease is often misdiagnosed, due to the fact that only mild or moderate symptoms occur, and these symptoms often take 20 years to present.

More severe cases of Coccidioidomycosis result in the infection spreading to other parts of the body through the bloodstream and individuals with a compromised immune system are at the greatest risk.

Features

• Coccidioidomycosis, also known as Valley fever or San Joaquin Valley fever, is a fungal infection caused by Coccidioides immitis spores. The infection is a result of inhaling the spores of this fungus, and therefore, the respiratory system is the first part of the body to be infected. Additionally, this condition primarily affects those who live in Texas, California, northern Mexico, New Mexico and South and Central America.

  There are several types of Coccidioidomycosis and they are as follows: acute, chronic pulmonary and disseminated. The acute type is fairly mild and highly uncommon and affects those in areas where the fungus is prevalent. Moreover, the chronic pulmonary type is even less common than the acute type and develops after 20 years or so due to lack of treatment resulting from a misdiagnosis.

  The disseminated form of this condition causes the infection to spread across the body through the bloodstream to bones, lungs, liver, brain and the brain lining and spine, brain, skin and heart.

  Individuals affected by the chronic pulmonary type typically suffer from pneumonia, while those with the disseminated form of the disease suffer from meningitis, osteomylelitis and joint infections. When pneumonia results, the individual will have chronic pulmonary nodules and/or skin lesions. Additionally, the joint that is most commonly affected are those in the knees.

Symptoms

• Joint stiffness, swelling or pain and arthritis are among the many symptoms of Coccidioidomycosis. Other symptoms include blood in the sputnum, chest pain, coughing, fever, headaches and loss of appetite.

Causes

• The infection is caused by first inhaling the spores of Coccidioides immitis, which are converted to spherules, resulting in the release of endospheres. These endospheres produce pneumonitis and inflammation, the latter causing the joint-related symptoms of the disease.

  Additionally, joint pain is caused by not only the infectious disease itself but also from the osteomyelitis, which was produced by the infectious disease. However, joint-related issues such as arthritis, bursitis and muscle pain only occur with the non-acute forms of the disease.

Diagnosis

• Coccidioidomycosis is oftentimes misdiagnosed as the acute form of the disease presents no symptoms and the forms of the disease present mild or moderate symptoms. Confirming the presence of, or lack of, this disease requires a Coccidioidin or Spherulin skin biopsy. Chest X-rays and sputum smears or cultures are used to diagnose the chronic pulmonary form of the disease, while CT scans are used to detect the disseminated form of the disease.

Prevention/Solution

• Acute Coccidioidomycosis typically requires no treatment; however, if flu-like symptoms or fever appear, the best treatment is bedrest until the symptoms go away. Other forms of the disease require antifungal treatment.

  Meanwhile, disseminated Coccidioidomycosis requires antifungal treatments such as ketoconazole, fluconazole, or itraconazole. Fluconazole is the prescribed treatment for individuals with mild-to-moderate chronic pulmonary Coccidioidomycosis who suffer from respiratory symptoms but are unaffected by meningitis. For severe cases of this disease, amphotericin B is the standard treatment.

  Furthermore, bone and joint infections may require physical or occupational therapy, depending on the nerves affected by the disease. A common neuropathy treatment for joint and muscle pain is transcutaneous electrical nerve stimulation or TENS. This treatment does not require medication as it is conducted through the skin.

Warning

• Those with a compromised immune system such as individuals who are pregnant, travel to the southwestern deserts in the United States, as well as those who suffer from HIV/AIDS or diabetes are at greater risk for developing the disseminated for of this disease.

  Left untreated, disseminated Coccidioidomycosis is usually fatal. When meningitis occurs as a result of this disease, antifungal treatment is most likely lifelong and removal of the infected bond may be necessary to cure osteomylelitis.