Last reviewed: 24 Feb 2023
Last updated: 27 Jul 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • asymptomatic
  • fever
  • cough
  • rash
More key diagnostic factors

Other diagnostic factors

  • headache
  • fatigue
  • pleuritic chest pain
  • dyspnoea
  • myalgia or arthralgia
  • weight loss
  • night sweats
  • chills
  • rales, rhonchi, wheeze, or rub
  • bronchial breathing
  • haemoptysis
  • pyopneumothorax
  • lymphadenopathy
  • abnormal mental status or neurological examination
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • sputum culture
  • enzyme immunoassay serology for coccidioidomycosis
  • immunodiffusion serology for coccidioidomycosis
  • complement fixation serology for coccidioidomycosis
  • FBC
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • antigen testing
  • lung biopsy
  • lumbar puncture
  • erythrocyte sedimentation rate
  • CT chest
  • bone scan
  • MRI
More investigations to consider

Treatment algorithm


mild coccidioidal pneumonia (non-pregnant)

severe or diffuse coccidioidal pneumonia (non-pregnant)

pulmonary nodule (non-pregnant)

asymptomatic pulmonary cavity (non-pregnant)

symptomatic pulmonary cavity (non-pregnant)

chronic progressive fibrocavitary coccidioidomycosis (non-pregnant)

skin and soft tissue coccidioidomycosis (non-pregnant)

skeletal coccidioidomycosis (non-pregnant)

coccidioidal meningitis (non-pregnant)




Janis E. Blair, MD

Professor of Medicine

Mayo Clinic College of Medicine and Sciences



Division of Infectious Diseases

Mayo Clinic




JEB declares that she has no competing interests.

Peer reviewers

Susan Hoover, MD

Infectious Diseases Clinic

Sanford Health Sioux Falls



SH declares that she has no competing interests.

Astrid Mayr, MD

Professor of Medicine

Department of Hygiene and Medical Microbiology

Medical University Innsbruck




AM declares that she has no competing interests.

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