When was coccidioidomycosis first identified?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Wernicke and Posadas first described a case of coccidioidomycosis in 1892 in South America, in an Argentinean soldier with predominantly cutaneous manifestations. Two years later in the United States, a patient with disseminated coccidioidomycosis was first reported in California in 1894.

In 1896, Rixford and Gilchrist reported a few cases in which they identified the infecting agent as a protozoanlike organism and named it Coccidioides immitis. Ophuls further described the fungal life cycle and pathology of C immitis in 1905.

The disease was considered rare and uniformly fatal until 1929, when a Stanford University medical student, Harold Chope, accidentally inhaled a culture of Coccidioides and developed a nonfatal pulmonary illness accompanied by erythema nodosum. This case sparked interest that resulted in researchers uncovering the association between C immitis and the clinical condition known as San Joaquin Valley fever. Charles E. Smith and colleagues subsequently developed coccidioidin skin test and serologic testing for coccidioidomycosis.

The importance of the illness increased during the 1930s and 1940s, starting with the influx of immigrants from the Midwest who arrived in the San Joaquin Valley of California to escape drought and to seek agricultural employment. The thousands of military personnel building airstrips and participating in desert combat training during World War II led to many important studies on the pathogenic organisms and the epidemiology, clinical features, and diagnosis of coccidioidomycosis by the military health services.

Interest in coccidioidomycosis has been renewed because of massive migration to the Sunbelt states. Areas that were once sparsely populated are now major cities, which increases the population at risk for the disease. Phoenix and Tucson, Arizona; Bakersfield and Fresno, California; and El Paso, Texas, are prime examples.

These locales also have a growing population of individuals who are unusually susceptible to the most serious consequences of infection, due to advanced age or immunocompromise. Interest also has increased because of an explosion in the number of cases that occurred during the great coccidioidomycosis outbreak in California in 1991-1994.

The first effective therapy for coccidioidomycosis, intravenous amphotericin B, was first used in 1957. Since the 1980s, various oral antifungal agents, including ketoconazole, itraconazole, and fluconazole, have led to further advances in the treatment of coccidioidomycosis. The roles of newer agents (eg, voriconazole, posaconazole, caspofungin) are still being explored.


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