title: Head and neck manifestations of disseminated coccidioidomycosis.
abstract: OBJECTIVE
  Coccidioidomycosis is a fungal disease endemic to semiarid regions in the southwestern United States, northern Mexico, and parts of South America. Although this is primarily a pulmonary disease, approximately 0.5% to 1.0% of infected individuals develop disseminated disease affecting skin, subcutaneous tissue, bone, joints, and meninges. The objectives of the study were to present three cases of head and neck manifestations of disseminated coccidioidomycosis and to review the literature of head and neck presentations, diagnosis, and treatment of this potentially life-threatening disease.
  
  
  METHODS
  Case reports and literature review.
  
  
  METHODS
  A Medline search was performed with the keyword "coccidioidomycosis." Of 1719 articles in all, 47 were selected for their relevance to otolaryngology, diagnosis, or treatment.
  
  
  RESULTS
  Virtually all head and neck manifestations in patients with disseminated coccidioidomycosis involved the skin, with a predilection for the central face. Systemic symptoms such as fever and cough are often subtle, making the diagnosis difficult. Infections of multiple sites of the head and neck have been reported, including life-threatening airway lesions.
  
  
  CONCLUSIONS
  The incidence of patients with coccidioidomycosis has been steadily increasing since the late 1980s in endemic areas. Otolaryngologists are increasingly being called on to diagnose and manage the head and neck manifestations of the disease caused by Coccidioides immitis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, California, USA.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Arnold
authors.forename: John C
authors.initials: JC
authors.lastname: Arnold
authors.forename: David C
authors.initials: DC
authors.lastname: Bloom
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Brewster
authors.forename: J Kim
authors.initials: JK
authors.lastname: Thiringer
mesh_terms: D000293:Adolescent; D002648:Child; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D003371:Cough / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D005624:Frontal Bone / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009333:Neck; D010256:Paranasal Sinuses / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery