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
...agnosi...
...s Endemic for Coccidioidomycosis...
...as within endemic regions of Arizo...
...n Hematogenous spread beyond the lungs n...
...ting Enzyme immunoassays (EIAs) for...
...opathology An alternative approach to dia...
...ditional Evaluation at the Time of Initial Dia...
...igure 3. Coccidioidal P...
Treatment
...eatment
...f Coccidioidomycosis in Patients Witho...
...ion and Physical Therapy Reconditioning Pro...
...ith uncomplicated pulmonary coccidioidomycosi...
...e IDSA recommends patient education, close obser...
...rting Antifungal Drug Therapy In Pati...
...IDSA recommends initiating antifungal tr...
...patients at the time of diagnosis with extensive...
...eatment is begun in nonpregnant adul...
...lmonary Coccidioidomycosis With an Asymptomatic P...
...is confirmation that a pulmonary nodule i...
...mptomatic Coccidioidal Cavity Without an Imm...
...he IDSA recommends against the use of antifungal t...
...hronic Cavitary Coccidioidal Pneumonia...
...IDSA recommends that patients with symptomatic chr...
The IDSA recommends that surgical o...
...SA recommends that when surgical man...
...ients with ruptured coccidioidal cavity...
...l space is massively contaminated, d...
...ients with ruptured coccidioidal ca...
...lmonary Soft Tissue Coccidioidomycosis, Not...
...recommends antifungal therapy in all...
...recommends oral azoles, in particular f...
...ommends intravenous AmB in cases of azole f...
...and/or Joint Coccidioidom...
...ecommends azole therapy for bone and joint coccidi...
...osseous disease, the IDSA recommends AmB...
The IDSA recommends surgical consu...
...ocedures are recommended in addition t...
...A recommends that surgical consultation be ob...
...wly Diagnosed Coccidioidal Infectio...
...ith recently diagnosed coccidioidal infecti...
...or coccidioidal meningitis (CM), the...
...M, the IDSA recommends azole treatme...
...s with CM who clinically fail initial therapy...
...ients with increased intracranial pr...
...patients who develop ICP will not resolve this pr...
...mmends that patients with ventriculoperitoneal s...
...shunt has developed a bacterial or other super...
...patients with CM who initially res...
...ent of Patients With Coccidioidomycosi...
...treatment of autologous or allogeneic...
For the treatment of patients with very severe and...
...s or allogeneic HSCT or solid organ trans...
...HSCT or solid organ transplant recipients wit...
...tial treatment of active coccidioidomycos...
...mmends oral azole therapy for recipients of bi...
...gnant Women With Coccidioidomycosis and Their Neon...
...ring Pregnan...
...velopment of symptomatic coccidioidomycosis duri...
...who develop initial nonmeningeal coccidioidal inf...
...include no therapy with close monitor...
...zole antifungal after educating the...
...trimester of pregnancy, an azole a...
...ative would be to administer intravenous AmB thro...
...ho develop CM during the first trimester of...
...he first trimester and in cases where dise...
...ong women with a history of prior unc...
...uch women, close follow-up, including obtaini...
...with nonmeningeal coccidioidomycosis...
...ernative to this, especially if the cocc...
...gnant woman with CM who is on azole antifunga...
...is period, one approach is to initiat...
...ngal therapy may then be restarted during the sec...
...hecal AmB continued throughout gestat...
...tive is to continue azole antifungal therapy th...
...alternative for the pregnant woman with...
...ent of a febrile pulmonary illness during preg...
...Neonates...
...IDSA recommends against coccidioid...
...therapy with fluconazole at 6–12 mg/kg daily i...
...eding is NOT recommended for mothers on azole ant...
HIV Co-Infection
...V Co-Infection...
...phylaxis is NOT recommended to prevent...
...ifungal therapy is recommended for all patients w...
...py should be continued as long as the periphera...
...patients with peripheral CD4 T-lymphocyte c...
...hin coccidioidal-endemic regions, patients s...
...ccidioidal-endemic regions, serologic screenin...
...are lacking, pediatric patients with HIV i...
...ation of potent antiretroviral therapy (ART...
...egies for Coccidioidomycosis in Special At-Risk P...
...s undergoing organ transplantation in t...
...patients in the endemic area, the IDSA r...
...IDSA does NOT recommend regular serologic scree...
Table 1. Recommended Drugs
...le 1. Recommended DrugsHaving trouble...