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Case Report Abortion and Disseminated UC Davis UC Davis Previously Published Works Title Case report: Abortion and disseminated infection by Coccidioides posadasii in an alpaca (Vicugna pacos) fetus in Southern California. Permalink https://escholarship.org/uc/item/3s75w9kk Journal Medical mycology case reports, 2(1) ISSN 2211-7539 Authors Diab, Santiago Johnson, Suzanne M Garcia, Jorge et al. Publication Date 2013-10-31 DOI 10.1016/j.mmcr.2013.10.002 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Medical Mycology Case Reports 2 (2013) 159–162 Contents lists available at ScienceDirect Medical Mycology Case Reports journal homepage: www.elsevier.com/locate/mmcr Case report: Abortion and disseminated infection by Coccidioides posadasii in an alpaca (Vicugna pacos) fetus in Southern California$ Santiago Diab a,n, Suzanne M. Johnson b, Jorge Garcia a, Erin L. Carlson b, Demosthenes Pappagianis b, Jana Smith c, Francisco A. Uzal a a California Animal Health & Food Safety Laboratory System (CAHFS), San Bernardino branch. University of California, Davis, CA, USA b Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA c Private Practitioner, Somis, CA, USA article info abstract Article history: Coccidioidomycosis is a fungal disease affecting humans and other mammals caused by the soil-dwelling Received 24 September 2013 fungi Coccidioides immitis and C. posadasii. Abortion due to Coccidioides spp. infection is rare in domestic Received in revised form animals and transplacental transmission is considered uncommon in women. This report describes a case 23 October 2013 of placental-fetal infection and abortion in an alpaca with disseminated C. posadasii infection. PCR Accepted 24 October 2013 amplification and DNA sequencing were used to confirm the etiology, C. posadasii, in fetal tissues. & 2013 The Authors. Published by Elsevier B.V. on behalf of International Society for Human and Animal Keywords: Mycology. All rights reserved. Coccidioides spp. Abortion Alpaca Camelids 1. Introduction illness to severe, life-threatening disease. While pregnancy is a risk factor for the development of severe and disseminated coccidioido- Coccidioidomycosis is a fungal disease affecting humans and other mycosis, no cases of abortion due to coccidioidomycosis have been mammals caused by the soil-dwelling fungi Coccidioides immitis and reported in humans [3]. South American camelids, such as llamas C. posadasii. The infection is usually acquired in the Americas. The (Lama glama)andalpacas(Vicugna pacos), are very susceptible to fungus is endemic in southwestern states of the United States, with coccidioidal infection and clinical cases usually present with severe the highest incidence in Arizona, California, Texas, and New Mexico respiratory and/or disseminated infection [4].However,transplacental [1]. It is generally accepted that the two species, C. immitis and C. fetal infection and subsequent abortion has not been previously posadasii, populate different geographic regions. C. immitis is more reported in South American camelids and is rare in other mammals commonly found in central and southern California and Mexico, [5,6]. This report describes a case of placental and fetal coccidioido- while C. posadasii has a broader region of endemicity, from central mycosis and subsequent abortion in an alpaca with the disseminated and southern Arizona to western Texas and southern New Mexico as form of the disease. PCR amplification and DNA sequencing were well as areas of Central and South America [2]. used to confirm the etiology, C. posadasii, in fetal tissues. Infection occurs normally via inhalation of arthroconidia, although transmission by direct inoculation may also occur. Hori- zontal (individual to individual) or vertical (mother to embryo/fetus) 2. Case transmissions are considered very rare [1]. Coccidioidomycosis con- sists of a spectrum of disease ranging from a mild, self-limited, febrile An aborted 9-month gestation alpaca fetus and placenta were submitted for necropsy and diagnostic work-up to the California Animal and Health Safety Laboratory, San Bernardino branch. The ☆This is an open-access article distributed under the terms of the Creative abortion occurred while the herd was located in Somis, Ventura Commons Attribution-NonCommercial-No Derivative Works License, which permits County, California. While the aborted dam never left California, non-commercial use, distribution, and reproduction in any medium, provided the other camelids on the premise had traveled briefly to shows in original author and source are credited. n Corresponding author. Tel.: þ1 530 752 1557. Arizona, New Mexico, Utah and Nevada. No other alpaca abortions E-mail addresses: [email protected], [email protected] (S. Diab). were reported on the premise in recent past or in several weeks 2211-7539/$ - see front matter & 2013 The Authors. Published by Elsevier B.V. on behalf of International Society for Human and Animal Mycology. All rights reserved. http://dx.doi.org/10.1016/j.mmcr.2013.10.002 160 S. Diab et al. / Medical Mycology Case Reports 2 (2013) 159–162 following this abortion. Prior cases of coccidioidomycosis occur- centered in the iris and extended onto the ciliary body and cornea. ring at the same farm included an adult alpaca, an 11-day old In the brain, pyogranulomas with spherules were observed in the alpaca cria, and a guard dog. A full postmortem examination of the leptomeninges and cerebral parenchyma. Additional laboratory fetus, and gross examination of the placenta were performed tests of the fetal lung included immunohistochemistry for equine and samples of heart, lungs, kidneys, liver, spleen, adrenal gland, herpesvirus type-1, bovine herpesvirus type-1, and bovine viral gastrointestinal tract, brain, tongue, skin, skeletal muscle, eye and diarrhea virus. The results were all negative. placenta were collected and fixed by immersion in 10% buffered A serum sample obtained from the dam at the time of the formalin, pH 7.4, for approximately 24 h before preparing 4 mm abortion was tested at the coccidioidomycosis serology laboratory at thick histological sections. These were subsequently stained with the University of California, Davis. The serum was positive for hematoxylin and eosin, and a few select sections were additionally coccidioidal IgG antibodies by qualitative immunodiffusion (in- stained with GMS and PAS. house assay) and the titer determined by quantitative immunodif- The fetus was in a mild to moderate state of post-mortem fusion (in-house assay) was 1:256, which is interpreted as an decomposition. Roughly spherical, slightly raised, white-grey and indicator of disseminated coccidioidomycosis. The dam was eutha- firm, 0.2–1 cm diameter nodules were detected (Fig. 1a and b) nized. A postmortem examination and histopathology revealed widely scattered throughout the lungs, spleen and intercostal disseminated coccidioidomycosis severely affecting the lungs skeletal muscles, less numerous on the diaphragm and skin, and (Fig. 2) and serosal membranes of the thoracic cavity, and mildly rare in the liver and heart. The skin nodules were observed on involving other organs such as the liver, kidneys, and uterine neck the face, ventral abdomen, perianal region, and rear legs. The eyes and horns. Fungal spherules similar to those described for the fetus showed marked external corneal opacity (edema) and a mid- were scant and were only seen within a few of the pyogranulomas sagittal section revealed anterior synechia and multiple white in the lungs and liver, but were not seen within the pyogranulomas nodules expanding the iris, ciliary body and cornea. The placenta of the kidneys or uterus. The dam was seropositive for bluetongue had many irregular, roughly round (2–3 cm diameter) areas of virus by a cELISA (VMRD Inc.) and seronegative for Brucella abortus hyperemia and hemorrhage covered by a fibrinous exudate on the by diagnostic card test (National Veterinary Services Laboratories), chorionic and allantoic surfaces (Fig. 1c). bovine viral diarrhea virus type-1 and 2 by serum viral neutralization Histologically, the lesions of the fetal and placental tissues consisted of multifocal pyogranulomas composed of a core of degenerate and viable neutrophils admixed with cellular debris (Fig. 1d). These were surrounded by numerous epithelioid macro- phages and a few lymphocytes, plasma cells and multinucleate giant cells, often admixed with hemorrhage, fibrin, edema and cellular debris. There were large numbers of round, 60–100 μm fungal spherules (sporangia) with a 4–5 μm thick refractile and hyaline double wall present in most tissues examined. These were either within or around the pyogranulomas and occasionally within the cytoplasm of surrounding multinucleate giant cells (Fig. 1e). The sporangia contained flocculent basophilic to ampho- philic material and, occasionally, multiple 5–7 μm endospores. The spherules stained positive with GMS and PAS. The pyogranuloma- Fig. 2. Dam's lung showing widespread, multifocal, granulomatous pneumonia tous inflammation with intralesional spherules in the eyes was caused by Coccidioides spp. Fig. 1. (a) Fetal lung depicting multifocal, variably sized, round, elevated, tan pyogranulomas. (b) Fetal spleen showing multifocal, variably sized, round, elevated, tan pyogranulomas. (c) Placenta showing a focal area of hyperemia and hemorrhage covered by a fibrinous exudate. (d) Microphotograph of the fetal lung showing a large, centrally mineralized
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