Last reviewed: 23 Apr 2022
Last updated: 11 Oct 2019
Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
- fever
- cough
- rash
More key diagnostic factors
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
Other diagnostic factors
Risk factors
- 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
- immunosuppression, especially suppression of cell-mediated immunity
- 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
- CBC
- chest x-ray
More 1st investigations to order
Investigations to consider
- lung biopsy
- lumbar puncture
- erythrocyte sedimentation rate
- CT chest
- bone scan
- MRI
More investigations to consider
Treatment algorithm
ACUTE
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.
Differentials
- Tuberculosis
- Nontuberculous pulmonary mycobacterial infections
- Community-acquired pneumonia
More DifferentialsGuidelines
- Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice
- Guidance for managing select communicable diseases: coccidioidomycosis (valley fever)
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