Coccidioidomycosis

Last updated April 8, 2022

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

...Diagnosis...

...s Endemic for Coccidioidomycosis...


...within endemic regions of Arizona have demonstr...


...  Hematogenous spread beyond the lungs normall...


...ological Testing  Enzyme immunoass...


...d Histopathology An alternative ap...


...onal Evaluation at the Time of Ini...


.... Coccidioidal Pneumoni...


Treatment

...Treat...

...Health E...

...complicated pulmonary coccidioidomy...

...commends patient education, close observat...

S...

...ecommends initiating antifungal treatmen...

...or patients at the time of diagnosis w...

...s begun in nonpregnant adults, the treatment shou...

...Pulmon...

...here is confirmation that a pulmon...

...Asymptomatic C...

...ommends against the use of antifungal therapy...

...Symptomatic Chroni...

...commends that patients with symptomatic chronic c...

...recommends that surgical options be explored w...

...ecommends that when surgical management of cavit...

...ts with ruptured coccidioidal cavity, the IDSA...

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

...s with ruptured coccidioidal cavities, oral a...

...Extrapul...

The IDSA recommends antifungal therapy in all c...

...SA recommends oral azoles, in parti...

...A recommends intravenous AmB in cases...

...Bone and/or Joint C...

...mends azole therapy for bone and joint coc...

...e osseous disease, the IDSA recommends Am...

...e IDSA recommends surgical consulta...

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

...IDSA recommends that surgical consultation b...

...Newly Diagnos...

...patients with recently diagnosed c...

...dioidal meningitis (CM), the IDSA reco...

...SA recommends azole treatment for l...

...ients with CM who clinically fail initial...

...with increased intracranial pressu...

...ause most patients who develop ICP...

...IDSA recommends that patients with ventricu...

...the shunt has developed a bacterial or othe...

...ith CM who initially respond to a treatme...


...Management of Pat...

...ment of autologous or allogeneic hematopoiet...

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

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

...neic HSCT or solid organ transplant recip...

...lowing initial treatment of active coccidi...

...IDSA recommends oral azole therapy for...

...During Pregnancy...

...t of symptomatic coccidioidomycosis during p...

...ho develop initial nonmeningeal coccidioid...

...options include no therapy with close monit...

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

...rst trimester of pregnancy, an azole antifung...

...alternative would be to administer intr...

...develop CM during the first trimester of preg...

...he first trimester and in cases wher...

...g women with a history of prior uncomp...

...such women, close follow-up, includ...

...men with nonmeningeal coccidioidom...

...ternative to this, especially if the coccid...

...pregnant woman with CM who is on azo...

...period, one approach is to initiat...

Azole antifungal therapy may then b...

...mB continued throughout gestation. ( W , L)7...

...ative is to continue azole antifun...

...ernative for the pregnant woman with...

...ent of a febrile pulmonary illness during pregnanc...

...For Neonates

The IDSA recommends against coccidioidal s...

...with fluconazole at 6–12 mg/kg da...

Breastfeeding is NOT recommended for moth...


HIV Co-Infection

...HIV Co-Infection...

...phylaxis is NOT recommended to prevent cocc...


...tifungal therapy is recommended for all patients...


...ngal therapy should be continued as long as the p...


...ents with peripheral CD4 T-lymphocyte...


...dioidal-endemic regions, patients should...


Outside coccidioidal-endemic regions, serol...


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


...potent antiretroviral therapy (ART) should not b...


...Pr...

...ll patients undergoing organ transplantation in th...

...r patients in the endemic area, the IDSA recommen...

...oes NOT recommend regular serologic screening or...


Table 1. Recommended Drugs

...mmended Drugs Drug Dos...