Coccidioidomycosis

Publication Date: August 30, 2016

Key Points

Key Points

Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic fungal infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Small pockets (i.e. southeast Washington state) may exist throughout the west.

Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection.

The most common syndrome to come to medical attention is a community-acquired pneumonia (CAP), often associated with a variety of rheumatologic, cutaneous, or systemic complaints.

Differences in disease severity are thought to be predominantly the consequence of differences in the immunologic responses to infection among individuals.

Figure 1. Estimated Numbers of Annual Infections in the United States and their Clinical Manifestations


Diagnosis

Diagnosi...

.... Areas Endemic for Coccidioidomycosis


Urban areas within endemic regions of...


...semination  Hematogenous spread beyond the lung...


...sting  Enzyme immunoassays (EIAs)...


...and Histopathology An alternative approa...


Additional Evaluation at the Time of Initial Dia...


.... Coccidioidal Pneumonia...


Treatment

...eatmen...

...Coccidioidomycosis in Patients Without Ov...

...ucation and Physical Therapy Reconditioning Prog...

...nts with uncomplicated pulmonary coccidio...

...e IDSA recommends patient education, close o...

...gal Drug Therapy In Patients With Newly Dia...

...A recommends initiating antifungal...

...the time of diagnosis with extensive pul...

...begun in nonpregnant adults, the tre...

Pulmonary Coccidioidomycosis With an Asymptoma...

...s confirmation that a pulmonary nod...

Asymptomatic Coccidioidal Cavity Without an Imm...

...ends against the use of antifungal...

...hronic Cavitary Coccidioidal Pneumon...

...ends that patients with symptomatic chronic...

The IDSA recommends that surgical options be expl...

...DSA recommends that when surgical ma...

...r patients with ruptured coccidioidal cavity...

...leural space is massively contaminated, decortica...

...r patients with ruptured coccidioidal caviti...

...onary Soft Tissue Coccidioidomycosis, Not Associat...

...recommends antifungal therapy in all cases o...

...mmends oral azoles, in particular f...

...e IDSA recommends intravenous AmB in cas...

...and/or Joint Coccidioidomycosi...

...e IDSA recommends azole therapy for bon...

...us disease, the IDSA recommends AmB...

...IDSA recommends surgical consultati...

...procedures are recommended in addition to...

...SA recommends that surgical consultation b...

...osed Coccidioidal Infection...

...s with recently diagnosed coccidioidal...

For coccidioidal meningitis (CM), the IDSA recomm...

...M, the IDSA recommends azole treatment...

...s with CM who clinically fail initial therapy w...

For patients with increased intracranial press...

...ost patients who develop ICP will not res...

...A recommends that patients with ventriculoperito...

...shunt has developed a bacterial or ot...

...nts with CM who initially respond to a treatment...


...ement of Patients With Coccidioidomycosis in Spec...

...treatment of autologous or alloge...

...ent of patients with very severe and/or rap...

...ogous or allogeneic HSCT or solid organ tr...

...neic HSCT or solid organ transplant recipients wit...

...initial treatment of active coccidioidomy...

...IDSA recommends oral azole therapy...

...ant Women With Coccidioidomycosis a...

...g Pregnancy...

...pment of symptomatic coccidioidomyco...

...omen who develop initial nonmeningeal coc...

...s include no therapy with close monitoring,...

...antifungal after educating the mother regardi...

...trimester of pregnancy, an azole antifungal, suc...

...lternative would be to administer intravenou...

...evelop CM during the first trimester of...

After the first trimester and in cases...

...ith a history of prior uncomplicated co...

...close follow-up, including obtaining...

...h nonmeningeal coccidioidomycosis on antifungal...

...o this, especially if the coccidioidal infection i...

...r the pregnant woman with CM who is on a...

...period, one approach is to initiate intratheca...

...ntifungal therapy may then be restarted during...

...mB continued throughout gestation. ( W , L)705...

...ve is to continue azole antifungal...

...lternative for the pregnant woman with CM...

...of a febrile pulmonary illness du...

...or Neonates...

...IDSA recommends against coccidioidal serolog...

...y with fluconazole at 6–12 mg/kg d...

...stfeeding is NOT recommended for mothers on...


HIV Co-Infection

...Co-Infection

...hylaxis is NOT recommended to prevent coccid...


...ungal therapy is recommended for all patien...


...apy should be continued as long as the p...


For patients with peripheral CD4 T-lymph...


...occidioidal-endemic regions, patients s...


...utside coccidioidal-endemic regions, serol...


...gh data are lacking, pediatric patients...


...f potent antiretroviral therapy (ART) s...


...rategies for Coccidioidomycosis in Special A...

...ll patients undergoing organ transplantation...

For patients in the endemic area, the I...

...DSA does NOT recommend regular serologic sc...


Table 1. Recommended Drugs

Table 1. Recommended DrugsHaving trouble view...