Coccidioidomycosis

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Última revisão: 1 May 2025

Última atualização: 27 Feb 2024

Coccidioidomycosis is a fungal infection caused by the endemic fungus Coccidioides species.

Most symptomatic coccidioidal infections are mild to severe episodes of pneumonia.

Extrapulmonary infection in sites such as skin, soft tissue, or skeletal or central nervous system occurs infrequently.

Common symptoms include fever, headache, dry cough, shortness of breath, inspiratory chest pain, myalgia, and arthralgia, and may be accompanied by a rash.

Treatment ranges from close observation without medical treatment in mild cases, to medical therapy, primarily with azole antifungals‚ in more severe episodes.

Azole antifungal therapy is generally well tolerated, with few adverse events; alternative treatments are rarely required.

Definição

Coccidioidomycosis is a fungal infection caused by the endemic fungus Coccidioides species and is acquired through inhalation of airborne arthrospores within the endemic areas of the southwest US, northern Mexico, and limited areas of Central and South America. Both humans and animals may become infected. Coccidioidomycosis may be asymptomatic or can cause acute and chronic pulmonary syndromes and, rarely, extrapulmonary infection. No human-to-human transmission of infection occurs.

História e exame físico

Principais fatores diagnósticos

asymptomatic
fever
cough
rash

Detalhes completos

Outros fatores diagnósticos

headache
fatigue
pleuritic chest pain
dyspnea
myalgia or arthralgia
weight loss
night sweats
chills
rales, rhonchi, wheeze, or rub
bronchial breathing
hemoptysis
pyopneumothorax
lymphadenopathy
abnormal mental status or neurologic exam

Detalhes completos

Fatores de risco

immunosuppression, especially suppression of cell-mediated immunity
occupation involving digging or construction
recreational activities that increase likelihood of dust inhalation
extremes of age
male sex
residing in or visiting endemic areas
African-American or Filipino ancestry
blood group B
pregnancy
HLA groups
diabetes mellitus

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

sputum culture
enzyme immunoassay serology for coccidioidomycosis
immunodiffusion serology for coccidioidomycosis
complement fixation serology for coccidioidomycosis
CBC
chest x-ray

Detalhes completos

Investigações a serem consideradas

antigen testing
polymerase chain reaction (PCR)
lung biopsy
lumbar puncture
erythrocyte sedimentation rate
CT chest
bone scan
MRI

Detalhes completos

Novos exames

lateral flow assay (LFA)

Algoritmo de tratamento

AGUDA

mild coccidioidal pneumonia (nonpregnant)

severe or diffuse coccidioidal pneumonia (nonpregnant)

pulmonary nodule (nonpregnant)

asymptomatic pulmonary cavity (nonpregnant)

symptomatic pulmonary cavity (nonpregnant)

chronic progressive fibrocavitary coccidioidomycosis (nonpregnant)

skin and soft tissue coccidioidomycosis (nonpregnant)

skeletal coccidioidomycosis (nonpregnant)

coccidioidal meningitis (nonpregnant)

pregnant

Colaboradores

Autores

Janis E. Blair, MD

Professor of Medicine

Mayo Clinic College of Medicine and Sciences

Rochester

Division of Infectious Diseases

Mayo Clinic

Phoenix

Declarações

JEB declares that she has no competing interests.

Revisores

Susan Hoover, MD

Infectious Diseases Clinic

Sanford Health Sioux Falls

Declarações

SH declares that she has no competing interests.

Astrid Mayr, MD

Professor of Medicine

Department of Hygiene and Medical Microbiology

Medical University Innsbruck

Innsbruck

Austria

Declarações

AM declares that she has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis. 2021 Dec;21(12):e364-74. Resumo

Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016 Sep 15;63(6):e112-46.Texto completo Resumo

Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections and diseases - coccidioidomycosis/valley fever. May 2023 [internet publication].Texto completo

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Coccidioidomycosis. 2021 [internet publication].Texto completo

Hage CA, Carmona EM, Epelbaum O, et al. Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019 Sep 1;200(5):535-50.Texto completo Resumo

Limper AH, Knox KS, Sarosi GA, et al; American Thoracic Society Fungal Working Group. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Tuberculosis
- Nontuberculous pulmonary mycobacterial infections
- Community-acquired pneumonia
Mais Diagnósticos diferenciais
Diretrizes
- CDC Yellow Book: health information for international travel - coccidioidomycosis/valley fever
- Clinical testing guidance for coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia
Mais Diretrizes
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Coccidioidomycosis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

mild coccidioidal pneumonia (nonpregnant)

severe or diffuse coccidioidal pneumonia (nonpregnant)

pulmonary nodule (nonpregnant)

asymptomatic pulmonary cavity (nonpregnant)

symptomatic pulmonary cavity (nonpregnant)

chronic progressive fibrocavitary coccidioidomycosis (nonpregnant)

skin and soft tissue coccidioidomycosis (nonpregnant)

skeletal coccidioidomycosis (nonpregnant)

coccidioidal meningitis (nonpregnant)

pregnant

Colaboradores

Autores

Janis E. Blair, MD

Declarações

Revisores

Susan Hoover, MD

Declarações

Astrid Mayr, MD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

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