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Primary Cutaneous Coccidioidomycosis: An Update

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Abstract

Coccidioidomycosis is an endemic mycosis of the southern United States, Northern Mexico, and South America. Primary cutaneous coccidioidomycosis, despite being a very rare clinical presentation, has shown an increasing incidence. An extensive literature search for cutaneous coccidioidomycosis cases was performed using the OLDMEDLINE, PubMed, Cochrane, LILACS and Google Scholar databases for studies published from January 1927 through December 21, 2019. Forty-two observational studies were included totaling 82 cases of primary cutaneous coccidioidomycosis. Narrative reviews, systematic reviews, and meta-analyses were also included. Additionally, an original case was included. Patients with primary cutaneous coccidioidomycosis share the same geographical and epidemiological characteristics as those with pulmonary or disseminated coccidioidomycosis. Most of the imported cases came from endemic areas. A large portion of cases had prior local skin trauma. Tissue culture is still the leading diagnostic method; nevertheless, molecular techniques such as polymerase chain reaction (PCR) are currently relevant to differentiate between species. First-line treatment consists of azoles; however, it has an excellent prognosis even without treatment. Primary cutaneous coccidioidomycosis should be considered a differential diagnosis of unusual infections or neoformations in any part of the body in resident populations of endemic areas or in patients with a previous history of travel to these areas.

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References

  1. Posadas A. Un nuevo caso de micosis fungoidea con posrospemias. An Cir Med Argent. 1892;15:585–97.

    Google Scholar 

  2. Laniado-Laborín R, Arathoon EG, Canteros C, Muñiz-Salazar R, Rendon A. Coccidioidomycosis in Latin America. Med Mycol. 2019;57:46–55. https://doi.org/10.1093/mmy/myy037.

    Article  Google Scholar 

  3. Hirschmann JV. The early history of coccidioidomycosis: 1892–1945. Clin Infect Dis. 2007;44(9):1202–7. https://doi.org/10.1086/513202.

    Article  PubMed  Google Scholar 

  4. Deresinski S, Mirels LF. Coccidioidomycosis: what a long strange trip it’s been. Med Mycol. 2019;57(Supplement_1):3–15. https://doi.org/10.1093/mmy/myy123.

    Article  Google Scholar 

  5. Kollath DR, Miller KJ, Barker BM. The mysterious desert dwellers: Coccidioides immitis and Coccidioides posadasii, causative fungal agents of coccidioidomycosis. Virulence. 2019;10:222–33. https://doi.org/10.1080/21505594.2019.1589363.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Overholt EL, Hornick RB. Primary cutaneous coccidioidomycosis. Arch Intern Med. 1964;114(1):149. https://doi.org/10.1001/archinte.1964.03860070195028.

    Article  CAS  PubMed  Google Scholar 

  7. Carroll GF, Haley LD, Brown JM. Primary cutaneous coccidioidomycosis: a review of the literature and a report of a new case. Arch Dermatol. 1977;113(7):933–6. https://doi.org/10.1001/archderm.1977.01640070067008.

    Article  CAS  PubMed  Google Scholar 

  8. Twarog M, Thompson G. Coccidioidomycosis: recent updates. Semin Respir Crit Care Med. 2015;36(05):746–55. https://doi.org/10.1055/s-0035-1562900.

    Article  PubMed  Google Scholar 

  9. Liu H, Zhao Y, Yi F, et al. Clinical features of coccidioidomycosis: analysis of 33 Chinese Cases. Acta Acad Med Sin. 2019;41:646–57. https://doi.org/10.3881/j.issn.1000-503X.10884.

    Article  Google Scholar 

  10. Bonifaz A, Tirado-Sánchez A, González G. Cutaneous coccidioidomycosis with tissue arthroconidia. Am J Trop Med Hyg. 2019;100:772–772. https://doi.org/10.4269/ajtmh.18-0700.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shiu J, Thai M, Elsensohn AN, Nguyen NQ, Lin KY, Cassarino DS. A case series of primary cutaneous coccidioidomycosis after a record-breaking rainy season. JAAD Case Rep. 2018;4(5):412–4. https://doi.org/10.1016/j.jdcr.2017.11.018.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Russell DH, Ager E, Wohltman W. Cutaneous coccidiomycosis masquerading as an epidermoid cyst: case report and review of the literature. Milit Med. 2017;182(1):e1665–e16681668. https://doi.org/10.7205/milmed-d-15-00549.

    Article  Google Scholar 

  13. Perez-Elizondo AD. Coccidioidomicosis cutánea. Imagen clínica. Rev Argent Dermatol. 2017; 98(4). https://radonline.org.ar/2018/01/01/coccidiodomicosis-cutanea-imagen-clinica/.

  14. Rivard SC, Satter E. Primary cutaneous coccidioidomycosis presenting as a recurrent preauricular cyst. Skinmed. 2016;14(2):142–4.

    PubMed  Google Scholar 

  15. Muñoz-Estrada VF, Verdugo-Castro PN, Muñoz- MR. Coccidioidomicosis cutánea primaria. Dermatol Rev Mex. 2016;60(6):531–5.

    Google Scholar 

  16. Moreno-Coutiño G, Arce M, Medina A, Amarillas-Villalva A, Salas-Vargas V, Madrigal-Kazem R, Arenas R. Coccidioidomicosis cutánea: Comunicación de seis casos mexicanos. Rev Chilena Infectol. 2015;32(3):339–43. https://doi.org/10.4067/s0716-10182015000400014.

    Article  PubMed  Google Scholar 

  17. Garcia-Garcia SC, Salas-Alanis JC, Gomez-Flores M, Gonzalez-Gonzalez SE, Vera-Cabrera L, Ocampo-Candiani J. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol. 2015;90(5):610–21.

    PubMed  Google Scholar 

  18. Beatty N, Al Mohajer M. Medical image of the week: cutaneous coccidioidomycosis. Southwest J Pulm Crit Care. 2015;11(5):226–7. https://doi.org/10.13175/swjpcc110.

    Article  Google Scholar 

  19. Tortorano AM, Carminati G, Tosoni A, Tintelnot K. Primary cutaneous coccidioidomycosis in an Italian Nun working in South America and Review of Published Literature. Mycopathologia. 2015;180(3–4):229–35. https://doi.org/10.1007/s11046-015-9895-0.

    Article  CAS  PubMed  Google Scholar 

  20. Dworak DP, Kapustiak J, Ehklassi TA, Patrianakos TD. Primary cutaneous coccidioidomycosis of the eyelid: a case report. Ophthal Plast Reconstr Surg. 2014;32(2):e40–e4141. https://doi.org/10.1097/IOP.0000000000000224(Epub ahead of print).

    Article  Google Scholar 

  21. Narang V, Garg B, Sood N, Goraya SK. Primary cutaneous coccidioidomycosis: first imported cases in north India. Indian J Dermatol. 2014;59:422.

    PubMed  PubMed Central  Google Scholar 

  22. Rojas-Garcia OC, Moreno-Treviño MG, Gonzalez-Salazar F, Salas-Alanis JC. Coccidioidomycosis cutanea primaria en infante. Gac Med Mex. 2014;150:175–6.

    PubMed  Google Scholar 

  23. Di Martino-Ortiz B, Riveros R, Rodriguez-Masi R, Bolla-de-Lezcano L. Coccidioidomicosis cutánea primaria. Piel (Barc). 2014;2(8):477–80. https://doi.org/10.1016/j.piel.2014.01.018.

    Article  Google Scholar 

  24. Welsh O, Vera-Cabrera L, Rendon A, Gonzalez G, Bonifaz A. Coccidioidomycosis. Clin Dermatol. 2012;30:573–91.

    PubMed  Google Scholar 

  25. Salas-Alanis JC, Ocampo-Candiani J, Cepeda-Valdes R, Gomez-Flores M, Bonifaz A. Primary cutaneous coccidioidomycosis: incidental finding. J Clin Exp Dermatol. 2012;3:2. https://doi.org/10.4172/2155-9554.1000147.

    Article  Google Scholar 

  26. Muñoz-Estrada VF, Tolosa MR, Paz BGAV. Coccidioidomicosis cutánea primaria: presentación de un caso con morfología Atípica. Rev Med UAS. 2012;3:141–4.

    Google Scholar 

  27. Ondo AL, Zlotoff BJ, Mings SM, Rochester LC, Shanler SD. Primary cutaneous coccidioidomycosis: an incidental finding. Clin Exp Dermatol. 2010;35(3):e42–e4343. https://doi.org/10.1111/j.1365-2230.2009.03552.x.

    Article  CAS  PubMed  Google Scholar 

  28. Gaidici A, Saubolle MA. Transmission of coccidioidomycosis to a human via a cat bite. J Clin Microbiol. 2009;47(2):505–6. https://doi.org/10.1128/JCM.01860-08.

    Article  PubMed  Google Scholar 

  29. Gao W, Zhang SL, Zhang XM, Zou Q. Case report of a primary cutaneous coccidioidomycosis and literature review. Pract Med. 2008;24(7):1262–3 (in Chinese).

    Google Scholar 

  30. Jaramillo-Moreno G, Velazquez-Arenaz L, Mendez-Olvera N, Ocampo-Candiani J. Primary cutaneous coccidioidomycosis: case report and review of the literature. Intern J Dermatol. 2006;45:121–3.

    Google Scholar 

  31. Chang A, Tung RC, McGillis TS, Bergfeld WF, Taylor JS. Primary cutaneous coccidioidomycosis. J Am Acad Dermatol. 2003;49:944–9.

    PubMed  Google Scholar 

  32. Kim A, Parker SS. Coccidioidomycosis: case report and update on diagnosis and management. J Am Acad Dermatol. 2002;46:743–7.

    PubMed  Google Scholar 

  33. Domínguez-Cota G, Zamora-Angulo LE, Osuna-Beltrán, E, Vega Rosas, CE, Coccidioidomicosis cutánea primaria. Estudio epidemiológico y clínico. Serie de 16 casos. CIMEL Ciencia e Investigación Médica Estudiantil Latinoamericana. 2001; 6:49–53. https://www.researchgate.net/publication/26619059_Coccidioidomicosis_cutanea_primaria_Estudio_epidemiologico_y_clinico_Serie_de_16_casos.

  34. Bonifaz A, Saul A, Galindo J, Andrade R. Primary cutaneous coccidioidomycosis treated with itraconazole. Int J Dermatol. 1994;33:720–2.

    CAS  PubMed  Google Scholar 

  35. Fusaro RM, Bansal S, Records RE. Some unusual periorbital dermatoses. Ann Ophthalmol. 1988;20:391–3.

    CAS  PubMed  Google Scholar 

  36. Zhu JJ, Luo YL, Liu JS. One case of skin coccidioidomycosis complex Kaposi sarcoma in AIDS patient. Chin J Dermatol. 1998;12(4):232–3.

    Google Scholar 

  37. Male O. Coccidioidomykose. Pilzdialog. 1987;3:39–40.

    Google Scholar 

  38. Franco-de-Arias CM, Segundo B, Mejía-de-Alejos MA, et al. Coccidioidomicosis experiencia clínica y terapeutica. Dermatol Venezol. 1986;24:2–4.

    Google Scholar 

  39. O’Brien JJ, Gilsdorf JR. Primary cutaneous coccidioidomycosis in childhood. Pediatr Infect Dis. 1986;5:485–6.

    PubMed  Google Scholar 

  40. Schwartz RA, Lamberts RJ. Isolated nodular cutaneous coccidioidomycosis. The initial manifestation of disseminated disease. J Am Acad Dermatol. 1981;4:38–46.

    CAS  PubMed  Google Scholar 

  41. Gonzalez-Ochoa A, Velasco-Castrejon O. Inoculacion primaria accidental de coccidioidomycosis a partir de un caso clinico. Rev Invest Salud Publica. 1976;36:227–33.

    CAS  PubMed  Google Scholar 

  42. Winn WA. Primary cutaneous coccidioidomycosis: reevaluation of its potentiality based on a study of three new cases. Arch Dermatol. 1965;92:221–8.

    PubMed  Google Scholar 

  43. Levan NE, Huntington RW. Primary cutaneous coccidioidomycosis in agricultural workers. Arch Dermatol. 1965;92:215–20.

    PubMed  Google Scholar 

  44. Sorenson RH, Cheu SH. Accidental cutaneous coccidioidomycosis in an immune person. Calif Med. 1964;100:44–7.

    Google Scholar 

  45. Goodman DH, Schabarum B. Primary cutaneous coccidioidomycosis: visible classic demonstration of delayed hypersensitivity. Ann Intern Med. 1963;59:84–90.

    CAS  PubMed  Google Scholar 

  46. Harrell ER, Honeycutt WM. Coccidiodomycosis: traveling fungus disease. Arch Dermatol. 1963;87:188–96.

    CAS  PubMed  Google Scholar 

  47. Smith CE, Pappagianis D, Levine HB, Saito MT. Human coccidioidomycosis. Bacteriol Rev. 1961;25:314–5.

    Google Scholar 

  48. Wright ET, Newcomer VD, Nelson NH. Primary inoculation coccidioidomycosis. Arch Dermatol. 1959;79:118–20.

    Google Scholar 

  49. Gan D, Guo ML, He YG. First case of primary cutaneous coccidioidomycosis. Chin J Pathol. 1958;2:107–14 (in Chinese).

    Google Scholar 

  50. Trimble JR, Doucette J. Primary cutaneous coccidioidomycosis: report of a case of a laboratory infection. Arch Dermatol. 1956;74:405–10.

    Google Scholar 

  51. Wilson JW, Smith CE, Plunkett OA. Primary cutaneous coccidioidomycosis; the criteria for diagnosis and a report of a case. Calif Med. 1953;79:233–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Imerman SW, Imerman CP. Granuloma coccidioides, primary cutaneous lesión: Treatment with the actual cautery: report of a case. Southwest Med. 1993;17:18–211.

    Google Scholar 

  53. Guy WH, Jacob FM. Granuloma coccidioides. Arch Dermatol. 1927;16:308–11.

    Google Scholar 

  54. Van Dyke MCC, Thompson GR, Galgiani JN, Barker BM. The rise of coccidioides: forces against the dust devil unleashed. Front Immunol. 2019;10:2188. https://doi.org/10.3389/fimmu.2019.02188.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Ampel NM. The complex immunology of human coccidioidomycosis. Ann N Y Acad Sci. 2007;1111(1):245–58. https://doi.org/10.1196/annals.1406.032.

    Article  CAS  PubMed  Google Scholar 

  56. Kirkland T. The quest for a vaccine against coccidioidomycosis: a neglected disease of the Americas. J Fungi. 2016;2(4):34. https://doi.org/10.3390/jof2040034.

    Article  CAS  Google Scholar 

  57. Kaffenberger BH, Shetlar D, Norton SA, Rosenbach M. The effect of climate change on skin disease in North America. J Am Acad Dermatol. 2017;76(1):140–7. https://doi.org/10.1016/j.jaad.2016.08.014.

    Article  PubMed  Google Scholar 

  58. Bialek B, Kern J, Hermann T, et al. PCR assays for identification of Coccidioides posadasii based on the nucleotide sequence of the antigen 2/proline-rich antigen. J Clin Microbiol. 2004;42:778–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. McCotter OZ, Benedict K, Engelthaler DM, et al. Update on the epidemiology of coccidioidomycosis in the United States. Med Mycol. 2019;57(Supplement_1):S30–S40. https://doi.org/10.1093/mmy/myy095.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Benedict K, McCotter OZ, Brady S, et al. No. SS-7. MMWR Surveill Summ. 2019;68:1–15.

    PubMed  PubMed Central  Google Scholar 

  61. Galgiani JN, Ampel NM, Blair JE, et al. Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016;63(6):e112–e14646. https://doi.org/10.1093/cid/ciw360.

    Article  PubMed  Google Scholar 

  62. Lynch FH, Maly CJ, Unwala R, Blair JE, DiCaudo DJ, Mangold AR. Disseminated coccidioidomycosis mimicking cicatricial alopecia. JAAD Case Rep. 2019;5(11):957–9. https://doi.org/10.1016/j.jdcr.2019.08.024.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Watson IT, Murzaku E. Cutaneous coccidiomycosis presenting with a facial plaque. Proc (Bayl Univ Med Cent). 2019. https://doi.org/10.1080/08998280.2018.1523643.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Stockamp NW, Thompson GR. Coccidioidomycosis. Infect Dis Clin N Am. 2016;30(1):229–46. https://doi.org/10.1016/j.idc.2015.10.008.

    Article  Google Scholar 

  65. Carpenter JB, Feldman JS, Leyva WH, DiCaudo DJ. Clinical and pathologic characteristics of disseminated cutaneous coccidioidomycosis. J Am Acad Dermatol. 2010;62(5):831–7.

    PubMed  Google Scholar 

  66. Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk factors for disseminated coccidioidomycosis, United States. Emerg Infect Dis. 2017;23:308–11. https://doi.org/10.3201/eid2302.160505.

    Article  CAS  PubMed Central  Google Scholar 

  67. Gabe LM, Malo J, Knox KS. Diagnosis and management of coccidioidomycosis. Clin Chest Med. 2017;38(3):417–33. https://doi.org/10.1016/j.ccm.2017.04.005.

    Article  PubMed  Google Scholar 

  68. Levine HB, Cobb JM, Smith CE. Immunity to coccidioi-domycosis induced in mice by purified spherule, arthrospore, and mycelial vaccines. Trans N Y Acad Sci. 1960;22:436–49. https://doi.org/10.1111/j.2164-0947.1960.tb00711.x.

    Article  CAS  PubMed  Google Scholar 

  69. Porte L, Valdivieso F, Wilmes D, et al. Laboratory exposure to Coccidioides: lessons learnt in a non-endemic country. J Hosp Inf. 2019;102:461–4. https://doi.org/10.1016/j.jhin.2019.03.006.

    Article  CAS  Google Scholar 

  70. Johnson R, Kernerman SM, Sawtelle BG, et al. A reformulated spherule-derived Coccidioidin (Spherusol) to detect delayed-type hypersensitivity in coccidioidomycosis. Mycopathologia. 2012;174(5–6):353–8.

    PubMed  Google Scholar 

  71. Galgiani JN. Coccidioidomycosis. West J Med. 1993;159(2):153–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Vucicevic D, Blair JE, Binnicker MJ, et al. The utility of Coccidioides polymerase chain reaction testing in the clinical setting. Mycopathologia. 2010;170(5):345–51.

    CAS  PubMed  Google Scholar 

  73. Engelthaler DM, Roe CC, Hepp CM, et al. Local population structure and patterns of western hemisphere dispersal for Coccidioides spp, the fungal cause of valley fever. MBio. 2016;7(2):e00550–e616 (Epub 2016/04/28).

    CAS  PubMed  PubMed Central  Google Scholar 

  74. van den Bossche H, Willemsens G, Cools W, Lauwers WF, Le Jeune L. Biochemical effects of miconazole on fungi. II. inhibition of ergosterol biosynthesis in Candida albicans. Chem Biol Interact. 1978;21:59–78.

    PubMed  Google Scholar 

  75. Thompson GR, Lewis JS, Nix DE, Patterson TF. Current concepts and future directions in the pharmacology and treatment of coccidioidomycosis. Med Mycol. 2019;57:S76–84. https://doi.org/10.1093/mmy/myy029.

    Article  CAS  PubMed  Google Scholar 

  76. Roden MM, Nelson LD, Knudsen TA, et al. Triad of acute infusion-related reactions associated with liposomal amphotericin B: analysis of clinical and epidemiological characteristics. Clin Infect Dis. 2003;36:1213–20. https://doi.org/10.1086/374553.

    Article  CAS  PubMed  Google Scholar 

  77. DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol. 2006;55(6):929–42. https://doi.org/10.1016/j.jaad.2006.04.039.

    Article  PubMed  Google Scholar 

  78. Gonzalez GM, Gonzalez G, Najvar LK, et al. Therapeutic efficacy of caspofunginalone and in combination with amphotericin B deoxycholate for coccidioidomycosis in a mouse model. J Antimicrob Chemother. 2007;60(6):1341–6.

    CAS  PubMed  Google Scholar 

  79. Levy ER, McCarty JM, Shane AL, et al. Treatment of pediatric refractory coccidioidomycosis with combination voriconazole and caspofungin: a retrospective case series. Clin Infect Dis. 2013;56(11):1573–8.

    CAS  PubMed  Google Scholar 

  80. Krogstad P, Johnson R, Garcia-Lloret MI, Heidari A, Butte MJ. Host–pathogen interactions in coccidioidomycosis: prognostic clues and opportunities for novel therapies. Clin Ther. 2019;41(10):1939–1954.e1. https://doi.org/10.1016/j.clinthera.2019.08.011.

    Article  PubMed  Google Scholar 

  81. Malaguarnera L, Musumeci M, Di Rosa M, Scuto A, Musumeci S. Interferon-gamma, tumor necrosis factor-alpha, and lipopolysaccharide promote chitotriosidase gene expression in human macrophages. J Clin Lab Anal. 2005;19:128e132.

    Google Scholar 

  82. Levine HB, Cobb JM, Smith CE. Immunity to coccidioidomycosis induced in mice by purified spherule, arthrospore, and mycelial vaccines. Trans N Y Acad Sci. 1960;22:436–49. https://doi.org/10.1111/j.2164-0947.1960.tb00711.x.

    Article  CAS  PubMed  Google Scholar 

  83. Pappagianis D. Evaluation of the protective efficacy of the killed Coccidioides immitis spherule vaccine in humans. The Valley Fever Vaccine Study Group. Am Rev Respir Dis. 1993;148:656–60. https://doi.org/10.1164/ajrccm/148.3.656.

    Article  CAS  PubMed  Google Scholar 

  84. Hung CY, Hsu AP, Holland SM, Fierer J. A review of innate and adaptive immunity to coccidioidomycosis. Med Mycol. 2019;57(Supplement_1):S85–S92. https://doi.org/10.1093/mmy/myy146.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Saville SP, Lazzell AL, Chaturvedi AK, Monteagudo C, Lopez-Ribot JL. Efficacy of a genetically engineered Candida albicans tet-NRG1 strain as an experimental live attenuated vaccine against hematogenously disseminated candidiasis. Clin Vaccine Immunol. 2009;16:430–2. https://doi.org/10.1128/CVI.00480-08.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Trinh SA, Echenique IA, Penugonda S, Angarone MP. Safety and efficacy of chronic suppressive azole therapy for endemic fungal infections in solid organ transplant recipients. Transpl Infec Dis. 2018;20(5):e12963. https://doi.org/10.1111/tid.12963.

    Article  CAS  Google Scholar 

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Acknowledgements

Thanks to Dr Sergio Lozano, for his support in the English language writing. Special thanks to our professor and friend, Dr Oliverio Welsh, for his dedication and teachings that inspired this work. We will miss him forever.

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  1. Dermatology Department, Facultad de Medicina y Hospital Universitario “Dr. José E. Gonzalez”, Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico

    Irving Llibran Reyna-Rodríguez, Jorge Ocampo-Candiani & Sonia Chavez-Alvarez

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Reyna-Rodríguez, I.L., Ocampo-Candiani, J. & Chavez-Alvarez, S. Primary Cutaneous Coccidioidomycosis: An Update. Am J Clin Dermatol 21, 681–696 (2020). https://doi.org/10.1007/s40257-020-00525-z

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