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
...Diagnosis...
...as Endemic for Coccidioidomycosis...
...Urban areas within endemic regions of...
Dissemination Hematogenous spread...
...erological Testing Enzyme immuno...
...lture and Histopathology An alt...
...Evaluation at the Time of Initial Diagnosis ...
...Coccidioidal Pneumonia...
Treatment
...Tre...
...Management o...
...Health Education and P...
...ith uncomplicated pulmonary coccidioidomycosis sho...
...SA recommends patient education, close...
...Startin...
...IDSA recommends initiating antifungal treatmen...
...s at the time of diagnosis with extensive...
...ent is begun in nonpregnant adults, the...
...Pulmonary...
...e there is confirmation that a pulmonary n...
...Asymptomatic...
...A recommends against the use of antifungal the...
...Symptoma...
...mmends that patients with symptomatic chronic cavi...
...IDSA recommends that surgical options...
...e IDSA recommends that when surgical manageme...
...ts with ruptured coccidioidal cavity, the IDSA re...
If the pleural space is massively contam...
For patients with ruptured coccidioidal c...
...Extrapulmonary Sof...
...nds antifungal therapy in all cases of extrapulm...
...ecommends oral azoles, in particular...
...IDSA recommends intravenous AmB in case...
...Bone and/or Jo...
...ecommends azole therapy for bone and join...
...seous disease, the IDSA recommends AmB as initia...
...ecommends surgical consultation for...
...rgical procedures are recommended in addition...
...nds that surgical consultation be obta...
...N...
...ts with recently diagnosed coccidioidal infec...
...coccidioidal meningitis (CM), the IDSA rec...
...A recommends azole treatment for life. (...
...patients with CM who clinically fail initial...
...nts with increased intracranial pr...
...ients who develop ICP will not resolve this...
...SA recommends that patients with vent...
...t has developed a bacterial or other sup...
...patients with CM who initially respond to...
...Management of Patien...
...the treatment of autologous or allogeneic hematop...
...treatment of patients with very severe and/o...
...s or allogeneic HSCT or solid organ tran...
...ogeneic HSCT or solid organ transplant recipien...
...tial treatment of active coccidioidom...
...IDSA recommends oral azole therapy for rec...
...Pregnant W...
...During Pregnan...
...development of symptomatic coccidioidomycosis d...
...women who develop initial nonmeninge...
...ther options include no therapy with...
...ntifungal after educating the mother r...
...first trimester of pregnancy, an azole antifu...
...tive would be to administer intravenous AmB...
For women who develop CM during th...
...e first trimester and in cases where disease is...
...ith a history of prior uncomplicated coccid...
...omen, close follow-up, including obtaining coc...
...th nonmeningeal coccidioidomycosis on antifung...
...rnative to this, especially if the coccidi...
...pregnant woman with CM who is on a...
...g this period, one approach is to in...
...therapy may then be restarted during...
...al AmB continued throughout gestation. ( W , L...
...is to continue azole antifungal therapy thro...
...tive for the pregnant woman with CM is...
...he development of a febrile pulmonary illne...
...For Neonates...
...IDSA recommends against coccidioidal s...
...with fluconazole at 6–12 mg/kg...
...ding is NOT recommended for mothers on azol...
HIV Co-Infection
...HIV Co-Infection...
...hylaxis is NOT recommended to prevent coccidio...
...therapy is recommended for all patie...
...al therapy should be continued as lon...
...ts with peripheral CD4 T-lymphocyte counts ≥...
...coccidioidal-endemic regions, patients should...
...idioidal-endemic regions, serologic...
...though data are lacking, pediatric patients...
...iation of potent antiretroviral therapy (ART) sho...
Pr...
...ients undergoing organ transplantation...
...in the endemic area, the IDSA recommends screeni...
...he IDSA does NOT recommend regular serologic...
Table 1. Recommended Drugs
...mmended Drugs Drug D...