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
...reas Endemic for Coccidioidomycos...
...eas within endemic regions of Arizona...
...Hematogenous spread beyond the lungs n...
...l Testing Enzyme immunoassays (EI...
...topathology An alternative approach to di...
...l Evaluation at the Time of Initial Di...
.... Coccidioidal Pneumonia...
Treatment
...atment
...agement of Coccidioidomycosis in Patients Wit...
...ation and Physical Therapy Reconditioning Progra...
...nts with uncomplicated pulmonary co...
...ends patient education, close observation,...
...rting Antifungal Drug Therapy In Patient...
...IDSA recommends initiating antifung...
...ts at the time of diagnosis with extensive pulmona...
If treatment is begun in nonpregnant adult...
...Coccidioidomycosis With an Asymptomat...
Once there is confirmation that a p...
...matic Coccidioidal Cavity Without an Immu...
...recommends against the use of antifungal thera...
...Chronic Cavitary Coccidioidal Pneumonia...
...IDSA recommends that patients with sympt...
...ecommends that surgical options be explored when...
...IDSA recommends that when surgica...
For patients with ruptured coccidioidal cav...
...the pleural space is massively contaminated, deco...
...patients with ruptured coccidioidal cavit...
...lmonary Soft Tissue Coccidioidomycosis, Not Assoc...
...e IDSA recommends antifungal therapy in all...
...e IDSA recommends oral azoles, in particula...
...nds intravenous AmB in cases of azole failur...
...Joint Coccidioidomycosis...
...IDSA recommends azole therapy for bone and...
...seous disease, the IDSA recommends AmB...
...recommends surgical consultation for all p...
...ures are recommended in addition to antifungal dr...
...ecommends that surgical consultatio...
...agnosed Coccidioidal Infection
...th recently diagnosed coccidioidal infection, th...
...occidioidal meningitis (CM), the IDSA r...
...IDSA recommends azole treatment for life. (...
...CM who clinically fail initial therapy with fluc...
...tients with increased intracranial pressure...
...use most patients who develop ICP will not...
...nds that patients with ventriculoperitoneal sh...
...en the shunt has developed a bacteria...
In patients with CM who initially re...
...Patients With Coccidioidomycosis in...
...ment of autologous or allogeneic h...
...reatment of patients with very severe and/or ra...
...logous or allogeneic HSCT or solid organ transpl...
...or allogeneic HSCT or solid organ transplant r...
...itial treatment of active coccidioidomyco...
...he IDSA recommends oral azole therapy for rec...
...nant Women With Coccidioidomycosis and Their Neo...
...ing Pregnancy...
...t of symptomatic coccidioidomycosis d...
...who develop initial nonmeningeal c...
...clude no therapy with close monitoring, ( W , L)70...
...n azole antifungal after educating the...
...irst trimester of pregnancy, an azole ant...
...native would be to administer intr...
...ho develop CM during the first trimester...
...the first trimester and in cases where di...
...h a history of prior uncomplicated coccidio...
...omen, close follow-up, including obtaining...
...with nonmeningeal coccidioidomycos...
An alternative to this, especially if...
...the pregnant woman with CM who is...
...uring this period, one approach is t...
...ungal therapy may then be restarted during th...
...hecal AmB continued throughout gestation. (...
...ve is to continue azole antifungal therapy through...
...final alternative for the pregnant woman with...
...elopment of a febrile pulmonary illn...
...r Neonate...
...ommends against coccidioidal serologic...
...mpiric therapy with fluconazole at 6–12 mg/kg da...
...tfeeding is NOT recommended for mothers on azol...
HIV Co-Infection
...o-Infection...
...phylaxis is NOT recommended to prevent co...
...tifungal therapy is recommended for all patients...
...fungal therapy should be continued as lon...
...with peripheral CD4 T-lymphocyte counts ≥2...
...ioidal-endemic regions, patients should...
...ioidal-endemic regions, serologic s...
...though data are lacking, pediatric patients with H...
...otent antiretroviral therapy (ART) should...
...ive Strategies for Coccidioidomycosis i...
...s undergoing organ transplantation...
...in the endemic area, the IDSA recommends scr...
...A does NOT recommend regular serologic screenin...
Table 1. Recommended Drugs
...e 1. Recommended DrugsHaving trouble viewi...