Mold Remediation >> Black Mold Removal

Coccidioidomycosis is caused by Coccidioides immitis, a dimorphic fungus that grows as a mold in the soil. The mold forms arthroconidia within the hypha, a type of conidia formation known as enteroarthric development (Figure 1) (4). C. immitis is the only species within the primary pathogenic fungi that has Black Mold Removal this type of conidia development. 

Alternate conidia undergo autolysis, Black Mold Removal leaving empty spaces between viable arthroconidia. The arthroconidia are released into the atmosphere when the wind ruptures the hypha. C. immitis infects humans and animals almost exclusively by the respiratory route (5). Once inhaled, the arthroconidia cluster in the lungs and undergo a dramatic morphologic change. 

The round cells, which develop into spherules, Black Mold Removal undergo repeated internal divisions until they are filled with hundreds to thousands of offspring, termed endospores. This process occurs over 48 to 72 hours (6). When the spherule ruptures, each released endospore has the capacity to develop into a mature spherule. The geographic distribution of coccidioidomycosis. 

Cross-hatching indicates the heavily disease-endemic area, Black Mold Removal single hatching, the moderately disease-endemic area. C. immitis is primarily found in desert soil. It is present in highest numbers in the San Joaquin Valley in California, southern Arizona, southern New Mexico, west Texas, and the desert areas of northern Mexico (Figure 2). 

The organism is also found in scattered foci in coastal southern California, southern Nevada, and Utah (7) and is endemic in a few areas in Central and South America, Black Mold Removal especially in Venezuela (7). C. immitis is distributed unevenly in the soil and seems to be concentrated around animal burrows and ancient Indian burial sites (8,9); it is usually found 4 to 12 inches below the surface of the soil (7). 

Since C. immitis infects humans by the respiratory route, exposure to dust is one critical factor determining the risk for infection (10). Coccidioidomycosis is not spread from person to person, Black Mold Removal except in extraordinary circumstances. Coccidioidomycosis probably had its most profound effect on the population of the United States during World War II when several training airfields were built in the San Joaquin Valley. 

The rate of new infections in military personnel was 8% to 25% per year (10). Coccidioidomycosis was the most common cause of hospitalization at many airbases in the Southwest. Though the death rate was very low, Black Mold Removal many soldiers were sick for weeks to months, and their training was completely disrupted. 

At least in part because of efforts to minimize dust, the infection rate declined as the war went on (10). The incidence of coccidioidomycosis varies with the season; it is highest in late summer Black Mold Removal and early fall when the soil is dry and the crops are harvested (10). If it rains at this time of the year (which is unusual in southern California), disease incidence declines as the amount of dust decreases. 

Dust storms are frequently followed by outbreaks of coccidioidomycosis. One particularly severe dust storm in 1977 carried dust from the San Joaquin Valley up to the San Francisco Bay area and resulted in hundreds of cases of nonendemic coccidioidomycosis in areas north of the San Joaquin Valley. More recently, Black Mold Removal an earthquake centered in Northridge, California, was associated with 170 cases of acute coccidioidomycosis in Ventura County, which normally has a low incidence of this disease. 

The airborne dust associated with landslides Black Mold Removal triggered by the earthquake was implicated in the increase in the number of cases (12). Occupational or recreational exposure to dust is also an important consideration. Agricultural workers, construction workers, or others (such as archeologists) who dig in the soil in the disease-endemic area are at increased risk for the disease. 

During World War II, C. E. Smith, one of the most perceptive and influential epidemiologists to study coccidioidomycosis, recommended dust control as a primary measure to reduce risk for exposure (10). However, Black Mold Removal because the desert is inherently dusty, many cases of coccidioidomycosis are acquired just by driving through the disease-endemic area. 

Clinical Illness C. immitis is transmitted by the respiratory route. Smith et al., Black Mold Removal in a prospective study of cases of coccidioidomycosis acquired during World War II by soldiers at three San Joaquin Valley airbases, skin-tested the airmen periodically and questioned them about illnesses in the interval. 

They found that most infections (60%) were asymptomatic and resolved spontaneously; 15% were not severe enough to require medical care, Black Mold Removal and 25% were clinically important and required a substantial amount of time off work (15). In symptomatic patients, the pulmonary illness ranges from a self-limited flulike illness to pneumonia (16). 

Approximately 5% of primary infections result in erythema nodosum or erythema marginatum with associated noninfectious arthritis; Black Mold Removal most of those patients have a self-limited infection (17). Particularly in persons with diabetes, multiple thin-walled chronic cavities tend to develop as a residual effect of pulmonary coccidioidomycosis (18). 

Unlike in tuberculosis, in coccidioidomycosis, dissemination almost always becomes evident within a few weeks of the primary pneumonia, Black Mold Removal although in cases of limited dissemination it may not become clinically evident until months later (15,19). Cocidioidomycosis can disseminate and cause miliary disease, bone and joint infection, skin disease, soft tissue abscesses, and meningitis (15,16). 

These extrapulmonary complications are uncommon (<5% of infections). The most common clinical presentations of coccidioidomycosis in immunocompetent patients (16). The risk for disseminated Black Mold Removal coccidioidomycosis is much higher among some ethnic groups, particularly African-Americans and Filipinos. 

In these ethnic groups, the risk for disseminated coccidioidomycosis is tenfold that of the general population (5,20). Presumably, Black Mold Removal a gene (or genes) that increases susceptibility to infection is more prevalent in these ethnic groups than in the general population. Such a resistance gene has been identified in mice (21-23), but not yet in humans. 

The mechanism by which the resistance genes affect the course of the disease in mice is not clear. Pregnant women Black Mold Removal and the immunosuppressed are also at high risk for developing disseminated disease (Figure 3) (24). One study demonstrated that the growth rate of spherules was influenced by human sex hormones, which may partially account for the increased risk of disseminated disease in pregnancy (25). 

Pregnancy also redirects the immune response toward humeral (TH2) immunity Black Mold Removal and away from delayed hypersensitivity (TH1) (26), which may influence resolution of coccidioidomycosis. Generalized suppression of cell mediated immunity also increases the risk of disseminated disease (27). Coccidioidomycosis is particularly severe in patients with organ transplants or AIDS. 

Though disseminated coccidioidomycosis is uncommon, and symptomatic coccidioidal pneumonia usually resolves without therapy, Black Mold Removal many of these patients are very ill for weeks to months. Galgiani reported that a group of college students in Tucson who had coccidioidomycosis required an average of six clinic visits before the disease resolved (16). Therefore, this can be an expensive illness in terms of medical costs and time lost from work or school, even when the infection resolves spontaneously.

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