A 42-year-old male construction worker in southern Arizona developed a cold-like illness, experiencing a chronic cough, chest pain, headaches, and general fatigue. When the symptoms did not abate after several weeks, he visited his physician who ordered microscopic examination and culture of his sputum specimen. Direct microscopic exam demonstrated the presence of large spherule structures full of endsospores. The specimen was cultured at both 25°C and 37°C. The plate incubated at 25°C grew tan colonies with a fluffy white center. Examination of these colonies microscopically showed branching septate hyphae. As the culture matured, the hyphae fragmented into arthrospores. What is the most likely diagnosis?

Question

Quizplus · Accepted Answer

The symptoms and sputum analysis indicate a fungal infection. The presence of spherules with endospores is indicative of Coccidioides, a fungus endemic to southern Arizona. The growth of tan colonies with fluffy white centers at 25°C, and the presence of branching septate hyphae that fragment into arthrospores, also supports the diagnosis of Coccidioidomycosis. Candidiasis typically presents with white, curd-like patches in the mouth or throat, while blastomycosis and histoplasmosis are endemic to other regions of the United States. Sporotrichosis typically presents with skin lesions following trauma or exposure to plant material.

A 42-Year-Old Male Construction Worker in Southern Arizona Developed a Cold-Like