Whole-genome sequencing (WGS) analysis of the recovered isolates demonstrated near identical genetic identity between soil and clinical isolates, further confirming endemic presence of infectious C. immitis
in Washington (13).
Histology demonstrated a granulomatous lesion with abundant lymphoplasmacytic chronic inflammatory infiltrate and multinucleated giant cells with spherical cytoplasmic inclusions of different size which correspond to the infectious agent C. immitis
Health-care providers should be aware that C. immitis
is present in south central Washington, and should consider the diagnosis in patients with clinically compatible illness who reside or have traveled in this area.
Fungal blood cultures grew C. immitis
the following day.
As in the first patient with subacute disease, this patient's CSF and sera were reactive for C. immitis
posadasii and 62 C. immitis
isolates from a broad geographic range (1); and 266 clinical C.
CDC tested all sera for the thermally dimorphic fungi C. immitis
Initial serologic tests were negative for antibodies to Francisella tularensis, Yersinia pestis, Mycoplasma species, Histoplasma capsulatum, and C. immitis
. On further analysis, using serum specimens concentrated 3-5 fold in an assay that detects IgM antibodies (immunodiffusion tube precipitin), nine of the 10 acute serum specimens from patients contained IgM antibodies to C.
DNA fragment libraries for each of the cluster-associated C. immitis
strains were constructed for sequence analysis on the SOLiD sequencing platform (Life Technologies, Foster City, CA, USA) according to the manufacturer's instructions.
Within 2 weeks of returning home, 27 travelers complained of influenza-like symptoms, and initial testing of acute serum specimens at CDC revealed antibodies to C. immitis
for one traveler.
Patients with C. immitis
infection may have chronic pneumonia, fungemia, and extrapulmonary dissemination to skin, bones, meninges, and other body sites.
Severe drought followed by heavy rainfall was identified as a factor possibly associated with the recent epidemic of coccidioidomycosis in California; this weather pattern may be important in facilitating the growth of C. immitis
and the airborne spread of arthroconidia to humans.