Encyclopedia

Wernicke’s disease

Coccidioidomycosis, also known as Wernicke’s disease, is an infectious disease caused by the fungus Coccidioides immitis and usually characterized by involvement of the lungs.

Wernicke’s disease manifests either as a lung disease that resolves without treatment /acute primary form/ or as a severe progressive infection spreading throughout the body and often leading to death /progressive form/. The development of the severe form often indicates a compromised immune system, usually due to the presence of AIDS.

In people who become infected while traveling, symptoms of the disease may develop upon returning home.

What are the symptoms?

Usually, the acute primary form of the disease is asymptomatic. If symptoms do develop, they appear 1-3 weeks after infection.

The disease is usually mild and is accompanied by an increase in body temperature, chest pain, chills, the appearance of a wet cough, sometimes mixed with blood, is possible.

In some people, the mucous membranes of the eyes /conjunctivitis/, joints /arthritis/ become inflamed, nodules form on the skin – erythema nodosum.
The progressive form of the disease is rare and can appear after a few days, months or even years after the acute primary infection.

In this case, symptoms include a slight increase in body temperature, loss of appetite, weight loss and muscle tone. The progression of the infection in the lungs is accompanied by an increase in dyspnea.

The infection can also spread from the lungs to the bones, joints, liver, kidneys and brain and its membranes.
What are the causes?
Spores of this type of fungus occur naturally in the soil . Farmers and other people working with the soil are most often infected.

Diagnosis

A doctor may suspect Wernicke’s disease if the above symptoms may develop in a person who lives or has recently traveled to areas where spread this infection.

If such a fungal infection is suspected, samples of secretions from the respiratory tract or pus are sent for laboratory tests. Antibodies sometimes appear in the blood at the beginning, but in the acute primary form of the disease they disappear, in the progressive form the antibodies remain.

Treatment of coccidioidomycosis

The acute form of the disease usually, without treatment, ends in complete recovery. Patients with the progressive form of Wernicke’s disease are treated with oral amphotericin B or fluconazole is prescribed.

In other cases, the disease is treated with itraconazole or ketoconazole. In limited involvement, for example in lesions of the skin, bones or joints, drug therapy can be effective, but relapses often occur after treatment is stopped.

The most severe cases of progressive disseminated Wernicke’s disease are often fatal, especially if a person develops meningitis, an infection of the membranes of the brain and spinal cord.

In such cases, fluconazole is prescribed, sometimes amphotericin B is introduced into the cerebrospinal fluid. It is necessary to continue the treatment for a very long time, often until the end of life. Without treatment, this type, that is, fungal meningitis, leads to death.

When to seek medical help?

• In case of elevated body temperature, cough, general malaise, chest pain, shortness of breath.
• In case of development of conjunctivitis, joint pain and erythema nodosum , that is erythema nodosum.

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