Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
- fever
- cough
- rash
Other diagnostic factors
- 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
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
Diagnostic tests
1st tests to order
- sputum culture
- enzyme immunoassay serology for coccidioidomycosis
- immunodiffusion serology for coccidioidomycosis
- complement fixation serology for coccidioidomycosis
- CBC
- chest x-ray
Tests to consider
- antigen testing
- polymerase chain reaction (PCR)
- lung biopsy
- lumbar puncture
- erythrocyte sedimentation rate
- CT chest
- bone scan
- MRI
Emerging tests
- lateral flow assay (LFA)
Treatment algorithm
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
Contributors
Authors
Janis E. Blair, MD
Professor of Medicine
Mayo Clinic College of Medicine and Sciences
Rochester
MN
Division of Infectious Diseases
Mayo Clinic
Phoenix
AZ
Disclosures
JEB declares that she has no competing interests.
Peer reviewers
Susan Hoover, MD
Infectious Diseases Clinic
Sanford Health Sioux Falls
SD
Disclosures
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
Disclosures
AM declares that she has no competing interests.
References
Key articles
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. Abstract
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.Full text Abstract
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].Full text
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].Full text
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tuberculosis
- Nontuberculous pulmonary mycobacterial infections
- Community-acquired pneumonia
More DifferentialsGuidelines
- 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
More Guidelines
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