It’s a point of privacy to the health institutions to avoid reporting laboratory acquired infections, especially with the Absence of a formal forum outside the institution, and absence of obligatory mechanism for reporting that over 500.000 workers in the USA alone are employed in laboratories dealing with wide range of microorganisms with a potential for direct transmission.
A 65 year old Indian male presents to the Employee Health Department with productive cough and hemoptysis for the last two weeks. He also complains of anorexia, fatigue and weight loss for the last 6 months. Review of systems was unrevealing. He has no past history of chronic illness. He is on no medications except for omeprazole and triamcinolone cream. He has no sick contacts nor was he exposed to TB. Socially he is married and has been living in Ohio for fifteen years since he moved from Houston, TX where he lived for 3 years, he has no history of recent travel outside the area. He does not smoke, drink alcohol nor use illicit drugs. Works as a lab technician dealing mostly with Coccidioides for the past 10 years, participating in a research projects. Denies any accidents or breaks of biosafety rules in level II research lab. Basic labs tests normal.Chest Xray showed increased fibrotic markings and a left upper lobe nodule (fig. 1). PPD skin test was negative as well as sputum acid fast bacilli. Coccidioidomycosis skin test and antibodies were positive.A CT of the chest demonstrated extensive bronchiectasis in the right middle lobe; calcified lymph nodes in the mediastinum and cavitating lesions in the apices bilaterally (fig. 2). Transbronchial biopsy and Mycobacterial cultures were negative. The fungal cultures revealed the classic arthroconidia (fig. 3). Patient was started on Fluconazole. Shortly after he started to feel better and to gain weight.
Coccidioidomycosis is a systemic infection caused by Dimorphic fungus Coccidioides immitis, initially recognized by Posada 1892, Coccidioides spp. is endemic to lower sonoran deserts of the western hemisphere including northern Mexico, southern Arizona, central and southern California, and westTexas, under normal conditions person to person transmission does not occur, apporoximately 100,000 infections occur in the united states each year, incidence of infection in endemic areas like Arizona is 0.43% with higher risk for pregnancy, immunosuppression, African American and Fillipinos . The laboratory hazard of this organism is related to its size (2–5 millimicrons), the arthroconidia are conducive to ready dispersal in air and retention in the deep pulmonary spaces. The much larger size of the spherule (30–60 millimicrons) considerably reduces the effectiveness of this form of the fungus as an airborne pathogen. Inhalation of arthroconidia from environmental samples or cultures of the mold form is a serious laboratory hazard. The CDC recommends Biosafety Level 2 practices and facilities for handling and processing clinical specimens, identifying isolates, and processing animal tissues. Animal Biosafety Level 2 practices and facilities are recommended for experimental animal studies when the route of challenge is parenteral, and Biosafety Level 3 for propagating and manipulating sporulating cultures already identified as C. immitis and for processing soil or other environmental materials.
Interestingly, this is the first reported laboratory acquired coccidiomycosis since 1978. since the implementation of more meticulous biosafety rules. We believe laboratory acquired Coccioidomycosis both under recognized and under reported.
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