Risk Factors and Risk Case Study

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Coccidioidomycosis Erythema Nodosum

Also known as valley fever or desert rheumatism, coccidioidomycosis is a fungal disease commonly reported in the Western Hemisphere, especially South-western U.S. (mainly California, Arizona, and Texas), Northern Mexico, as well as parts of Central and South America (Chen, Lee & Li, 2010). In the U.S., estimates indicate that 150,000 people in the South-western region are infected every year (Garcia et al., 2015). As the disease is mainly concentrated in South-western U.S., its national prevalence remains unknown. The disease is commonly characterized by coughing, fever, shortness of breath, headaches, chest pain, night sweating, loss of weight, and erythema nodosum (Garcia et al., 2015). This paper reports a case of coccidioidomycosis characterized by erythema nodosum

Subjective

A 31-year-old Asian male visited his primary care doctor's clinic complaining of cough and malaise for two months. He had been a construction worker in Fresno County, California, for eleven months and the symptoms showed after he started work in Fresno County. He developed a temporary low-level fever; however, resisted night sweats, hemoptysis, as well as, headache. He was, however, positive for skin rashes characterized by painful red and brown bumps. The rashes were mostly on the lower limps, with a few on his chest, arms, and back. Some rashes appeared as raised red rashes with blisters or eruptions that looked like pimples. His previous medical record revealed no significant illnesses, and he did not smoke or take drugs.

Objective

No significant diagnostic studies had previously been done on the patient. Nonetheless, inspection, palpation, percussion, and auscultation were conducted to examine all systems associated with the patient's complaint. Percussion involved examining the condition of the thorax and the abdomen, while auscultation was done using a stethoscope, particularly focusing on the circulatory and respiratory systems. Following percussion, no solid mass or hollow structure was detected on the patient's thorax and abdomen. Auscultation, however, revealed some unusual sounds in the chest.

Coccidioidomycosis occurs in a variety of clinical forms, ranging from mild fever to severe pulmonary or cutaneous manifestations.

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Primarily, the disease occurs in the lungs (Garcia et al., 2015). Indeed, lungs comprise the most common site of infection. Lungs are affected as a result of direct inhalation of arthroconidia, leading to pulmonary coccidioidomycosis. Pulmonary coccidioidomycosis is the most common form of coccidioidomycosis, with 60% of victims often being asymptomatic and the rest 40% showing pulmonary symptoms 1-3 weeks following exposure to arthroconidia (Garcia et al., 2015). Common symptoms include fever, coughing, arthralgias, headache, intense fatigue, and chest pain, with symptoms in the acute phase persisting for more than three months (Chen, Lee & Li, 2010). Based on this premise, the unusual sounds in the patient's chest could have been an indication of pulmonary complications.

Inspection involved examining body features, skin color, as well as frequency and quantity of breaths during respiration. Physical examination did not reveal significant abnormalities. No abdominal discomfort, oral lesions, and conjunctivitis were observed. However, the patient had reddish rashes on his lower limps, arms, chest, and back. Following palpation, the rashes were tender and with blisters. Primary lung infection can spread to other body organs, notably the skin, the musculoskeletal system, and the nervous system. This is known as disseminated coccidioidomycosis (Odio et al., 2017). Disseminated coccidioidomycosis affects up to 5% of coccidioidomycosis patients, and often manifests clinically within 24 months of exposure (Garcia et al., 2015). The skin is the most common site of disseminated coccidioidomycosis. Cutaneous manifestations of coccidioidomycosis involve various forms, including erythema nodosum, erythema multiforme, sweet's syndrome, and acute exanthema. Erythema nodosum is the most common form, manifesting 1-3 weeks following primary respiratory signs (Garcia et al., 2015). It is characterized by numerous erythematous, excruciating lumps commonly occurring in the lower extremities (Chen, Lee & Li, 2010). Therefore, coupled with fever and malaise, the rashes observed on the patient's skin were consistent with erythema nodosum.

Assessment

The patient had mild fever (38.1oC). Blood and metabolic analysis did not indicate any anomalies in normal white blood cell count, atypical lymphocytes, erythrocytes, serum creatinine,.....

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