Coccidioidomycosis
Key Points
Key Points
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
...iagnosis...
...igure 2. Areas Endemic for Coccidioido...
...eas within endemic regions of Arizon...
...mination Hematogenous spread b...
...ical Testing Enzyme immunoassays (EIAs) fo...
...and Histopathology An alternative...
...ional Evaluation at the Time of Initial Di...
...igure 3. Coccidioidal Pneumonia
Treatment
...eatment...
...ement of Coccidioidomycosis in Patients Without Ov...
...cation and Physical Therapy Reconditio...
Patients with uncomplicated pulmonary coccidioido...
...ends patient education, close observation, and...
...ifungal Drug Therapy In Patients With Ne...
...recommends initiating antifungal treatment...
...at the time of diagnosis with extensive pulmon...
...eatment is begun in nonpregnant adults, the tre...
...ccidioidomycosis With an Asymptomatic Pulmo...
...there is confirmation that a pulmonary...
...omatic Coccidioidal Cavity Without an Immunosup...
...IDSA recommends against the use of antifungal...
...ic Chronic Cavitary Coccidioidal Pneumonia...
...ends that patients with symptomatic ch...
...DSA recommends that surgical options be explo...
...ecommends that when surgical management of ca...
...with ruptured coccidioidal cavity, the IDS...
...ural space is massively contaminated, decorticatio...
...ith ruptured coccidioidal cavities, or...
...onary Soft Tissue Coccidioidomycosis,...
...SA recommends antifungal therapy in all cas...
...A recommends oral azoles, in particular...
...recommends intravenous AmB in cases of azole f...
...e and/or Joint Coccidioidomycosis...
...he IDSA recommends azole therapy f...
...osseous disease, the IDSA recommends A...
...DSA recommends surgical consultation for all patie...
...res are recommended in addition to antifunga...
...nds that surgical consultation be obtained periodi...
...sed Coccidioidal Infection...
...n patients with recently diagnosed coc...
...occidioidal meningitis (CM), the IDSA recomme...
...A recommends azole treatment for life. ( S , M)...
...tients with CM who clinically fail...
...patients with increased intracranial p...
...e most patients who develop ICP will not re...
...commends that patients with ventriculoperitonea...
...n the shunt has developed a bacterial or...
...ients with CM who initially respond t...
...gement of Patients With Coccidioidomycosis in Spec...
...nt of autologous or allogeneic hemat...
...tment of patients with very severe and/or...
...s or allogeneic HSCT or solid organ transpl...
...llogeneic HSCT or solid organ transpla...
...g initial treatment of active coccidioidomycosis,...
...IDSA recommends oral azole therapy for re...
...men With Coccidioidomycosis and Their Neonat...
...ng Pregnanc...
...of symptomatic coccidioidomycosis...
...who develop initial nonmeningeal coccidioidal...
...nclude no therapy with close monitoring, ( W , L...
...ifungal after educating the mother regarding pot...
...st trimester of pregnancy, an azole antifungal,...
...l alternative would be to administ...
...or women who develop CM during the...
After the first trimester and in cases whe...
...en with a history of prior uncomplicated...
...r such women, close follow-up, including obt...
...r women with nonmeningeal coccidioidomycosis on...
...tive to this, especially if the cocci...
...e pregnant woman with CM who is on azole anti...
...ing this period, one approach is to initiate int...
...ungal therapy may then be restarted dur...
...thecal AmB continued throughout gestation...
...ve is to continue azole antifungal therapy throu...
...l alternative for the pregnant woman w...
...ent of a febrile pulmonary illness during pregn...
...or Neonates...
...mmends against coccidioidal serolo...
...iric therapy with fluconazole at 6–12...
...astfeeding is NOT recommended for mothers on...
HIV Co-Infection
...Co-Infection...
...gal prophylaxis is NOT recommended...
...herapy is recommended for all patients...
...apy should be continued as long as the per...
...patients with peripheral CD4 T-lymphocyte counts...
...occidioidal-endemic regions, patients should...
...ioidal-endemic regions, serologic screening is...
...are lacking, pediatric patients with HIV infec...
...potent antiretroviral therapy (ART) sh...
...ive Strategies for Coccidioidomycosis in Sp...
...all patients undergoing organ transplantat...
...tients in the endemic area, the IDSA...
...IDSA does NOT recommend regular serol...
Table 1. Recommended Drugs
Table 1. Recommended DrugsHaving trouble viewi...