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

...agnosis...

...ure 2. Areas Endemic for Coccidioidom...


...Urban areas within endemic regions...


DisseminationĀ  Hematogenous sprea...


...rological TestingĀ  Enzyme immunoassay...


...opathology An alternative approach t...


...ional Evaluation at the Time of Initia...


...igure 3. Coccidioidal Pn...


Treatment

...atment...

Management of Coccidioidomycosis in Pa...

Health Education and Physical Therapy Reconditi...

...with uncomplicated pulmonary coccidi...

...recommends patient education, close observ...

...ungal Drug Therapy In Patients With Newly D...

...A recommends initiating antifungal...

...or patients at the time of diagnosis with extens...

...treatment is begun in nonpregnant adult...

...onary Coccidioidomycosis With an Asymptomatic...

...e is confirmation that a pulmonary nodule is due...

...ymptomatic Coccidioidal Cavity Without a...

...IDSA recommends against the use of antifungal...

...Chronic Cavitary Coccidioidal Pneumonia...

...recommends that patients with symptomatic chroni...

...ends that surgical options be explored...

...SA recommends that when surgical management...

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

...space is massively contaminated, deco...

...r patients with ruptured coccidioi...

...y Soft Tissue Coccidioidomycosis, No...

...ommends antifungal therapy in all cases of ex...

...A recommends oral azoles, in particular fluc...

...ecommends intravenous AmB in cases...

...nd/or Joint Coccidioidomycosis...

...ends azole therapy for bone and joint coccidioi...

...osseous disease, the IDSA recommends...

...commends surgical consultation for all patie...

...ical procedures are recommended in addi...

...he IDSA recommends that surgical consu...

...Diagnosed Coccidioidal Infect...

...n patients with recently diagnosed coccidioidal...

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

...IDSA recommends azole treatment for...

...tients with CM who clinically fail in...

...ients with increased intracranial press...

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

...SA recommends that patients with ventriculoperiton...

...en the shunt has developed a bacterial or other su...

...with CM who initially respond to a treatm...


...nagement of Patients With Coccidioidomyco...

...r the treatment of autologous or allogene...

...or the treatment of patients with ve...

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

...geneic HSCT or solid organ transplant recipients...

...initial treatment of active coccidi...

...DSA recommends oral azole therapy for recipients...

...t Women With Coccidioidomycosis and Their Neon...

...uring Pregnanc...

...development of symptomatic coccidioi...

...or women who develop initial nonmeningeal...

...her options include no therapy with...

...ifungal after educating the mother regardi...

...e first trimester of pregnancy, an azole a...

...native would be to administer intravenou...

...or women who develop CM during the first trime...

...rst trimester and in cases where disease is dia...

...ng women with a history of prior uncom...

...close follow-up, including obtainin...

...nonmeningeal coccidioidomycosis on antifu...

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

...nt woman with CM who is on azole antifunga...

...his period, one approach is to initia...

...le antifungal therapy may then be restarted duri...

...cal AmB continued throughout gestation. ( W , L...

...tive is to continue azole antifungal...

...final alternative for the pregnant woman wit...

...t of a febrile pulmonary illness d...

For Neon...

...e IDSA recommends against coccidioidal s...

...erapy with fluconazole at 6ā€“12 mg/kg daily is r...

...ng is NOT recommended for mothers on azo...


HIV Co-Infection

HIV Co-Infectio...

...prophylaxis is NOT recommended to prev...


Antifungal therapy is recommended for all pati...


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


...atients with peripheral CD4 T-lymphocyte co...


...ioidal-endemic regions, patients should receiv...


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


...ata are lacking, pediatric patient...


...iation of potent antiretroviral therapy (ART) sho...


...Strategies for Coccidioidomycosis in Sp...

...s undergoing organ transplantation in the endemic...

...or patients in the endemic area, the IDSA...

...IDSA does NOT recommend regular serologic...


Table 1. Recommended Drugs

...1. Recommended DrugsHaving trouble viewing ta...