A California farmer developed a low-grade fever, myalgia, and cough. A chest X-ray exam revealed an infiltrate in the lung. Microscopic examination of the sputum revealed round, budding cells. A sputum culture grew mycelia and arthroconidia. What organism is most likely the cause of the symptoms? How is this disease transmitted? How might it be prevented?

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Answer:

The fungus Coccidioides immitis is the most likely organism to be causing these symptoms. This organism causes a lung infection disease known as coccidioidomycosis, also called San Joaquin Valley Fever or just Valley Fever. This disease is transmitted by breathing in the spores of the fungus which are present in dust. It might be prevented by avoiding dusty areas and wearing protective masks when being exposed to dust, utilizing air filters, keeping windows closed during dust storms and avoiding activities such as digging and gardening; all of these in areas where the fungus is common.

Explanation:

  • Coccidioidomycosis is a fungal disease caused by the organisms Coccidioides immitis in California and Coccidioides posadasii in other US southwestern states, northern Mexico and other arid regions in South America.

  • This disease also receives the names of "San Joaquin Valley Fever" and "Valley Fever" because it was first described in this region of California.

  • The fungus is found on the ground, the fungal spores are inhaled with dust and that's how they reach the lungs.

  • The disease consists of a lung infection. Many times it presents only symptoms similar to those of the flu (cough, fever, sore throat) and goes away without treatment. Other times, in complicated cases, the disease presents more like a pneumonia-like illness and spreads from the lungs into other parts of the body such as brain, joints and bones. Treatment is needed in these cases and is based on antifungal drugs.

  • Diagnosis is made examining the patient's sputum (presence of the fungus), blood (presence of antibodies against the fungus) and chest X-ray (evidence of infection).

To answer the question, the person talked about lives in California (a place where this disease is endemic), he works as a farmer (exposed to soil & dust) and presents with flu-like symptoms. His chest X-ray shows evidence of a lung infection, and the laboratory examination of his sputum shows presence of the fungus, confirming the diagnosis.

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