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
...gure 2. Areas Endemic for Coccidioidomycosis...
...Urban areas within endemic regions of A...
...ation Hematogenous spread beyon...
...rological Testing Enzyme immunoassays (EIA...
...re and Histopathology An altern...
...ional Evaluation at the Time of Initial Diagnosi...
...Coccidioidal Pneumonia...
Treatment
...Treatment...
...Man...
...Health Education...
...ients with uncomplicated pulmonary coccidioido...
...recommends patient education, close observ...
...Starting...
...ends initiating antifungal treatment fo...
...r patients at the time of diagnosis with...
...eatment is begun in nonpregnant adults, the tre...
...Pulmonary Cocc...
...ce there is confirmation that a pulmonary nodu...
...Asymptomatic C...
...IDSA recommends against the use of antifunga...
...S...
...ommends that patients with symptomatic chr...
...nds that surgical options be explored when the c...
...commends that when surgical managemen...
...nts with ruptured coccidioidal cavity, the ID...
...space is massively contaminated, decorticatio...
...r patients with ruptured coccidioidal caviti...
...Extrapulmonary...
...e IDSA recommends antifungal therapy in...
...ecommends oral azoles, in particular...
...ecommends intravenous AmB in cases of azol...
...Bone and/or Joint...
...ommends azole therapy for bone and joint co...
...ere osseous disease, the IDSA recommends AmB...
...recommends surgical consultation for a...
...ical procedures are recommended in add...
...A recommends that surgical consultation be obtai...
...Newly Di...
...with recently diagnosed coccidioidal infect...
...ccidioidal meningitis (CM), the IDSA...
...r CM, the IDSA recommends azole treatme...
...CM who clinically fail initial the...
...ts with increased intracranial pre...
...ecause most patients who develop ICP will no...
...IDSA recommends that patients with ventricu...
...the shunt has developed a bacterial or other...
...atients with CM who initially respond to a treatme...
...Management...
...the treatment of autologous or allogeneic hemat...
...the treatment of patients with very seve...
...ous or allogeneic HSCT or solid org...
...eneic HSCT or solid organ transplant recipien...
...l treatment of active coccidioidomy...
...IDSA recommends oral azole therapy...
...Pregna...
...During Pregnancy...
...development of symptomatic coccidioidomycosis dur...
...evelop initial nonmeningeal coccidioidal infec...
...clude no therapy with close monitoring, (...
...zole antifungal after educating the mothe...
...ter the first trimester of pregnancy, an azole ant...
...native would be to administer intravenous Am...
...who develop CM during the first trimest...
...trimester and in cases where disease is diagnos...
...th a history of prior uncomplicate...
For such women, close follow-up, i...
...with nonmeningeal coccidioidomycosis...
...ternative to this, especially if the coccid...
...e pregnant woman with CM who is on azol...
...this period, one approach is to ini...
...al therapy may then be restarted during the se...
...thecal AmB continued throughout gesta...
An alternative is to continue azole antifungal t...
...inal alternative for the pregnant woman with...
...he development of a febrile pulmonary illness...
...For Neonates...
...commends against coccidioidal serolo...
Empiric therapy with fluconazole at 6–12 mg/...
...g is NOT recommended for mothers on azole antif...
HIV Co-Infection
...HIV Co-Infection...
...ungal prophylaxis is NOT recommende...
...ntifungal therapy is recommended for all patient...
...ungal therapy should be continued as long as th...
...ith peripheral CD4 T-lymphocyte counts ≥2...
...ithin coccidioidal-endemic regions, patients...
...idioidal-endemic regions, serologic screenin...
Although data are lacking, pediatric patien...
...tiation of potent antiretroviral th...
...Preemptive Strateg...
...ts undergoing organ transplantation in the en...
...s in the endemic area, the IDSA recomm...
...e IDSA does NOT recommend regular serologic s...
Table 1. Recommended Drugs
...le 1. Recommended DrugsHaving trouble...