Most symptomatic coccidioidal infections are mild to severe episodes of pneumonia caused by Coccidioides species.
Extrapulmonary infection in sites such as skin, soft tissue, or skeletal or central nervous system occurs infrequently.
Common symptoms include fever, headache, dry cough, 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.
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.
History and exam
Key diagnostic factors
Other diagnostic factors
- pleuritic chest pain
- myalgia or arthralgia
- weight loss
- night sweats
- rales, rhonchi, wheeze, or rub
- bronchial breathing
- abnormal mental status or neurologic exam
- 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
- HLA groups
- diabetes mellitus
1st investigations to order
- sputum culture
- enzyme immunoassay serology for coccidioidomycosis
- immunodiffusion serology for coccidioidomycosis
- complement fixation serology for coccidioidomycosis
- chest x-ray
Investigations to consider
- lung biopsy
- lumbar puncture
- erythrocyte sedimentation rate
- CT chest
- bone scan
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)
Janis E. Blair, MD
Professor of Medicine
Mayo Clinic College of Medicine and Sciences
Division of Infectious Diseases
JEB declares that she has no competing interests.
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.
- Nontuberculous pulmonary mycobacterial infections
- Community-acquired pneumonia
- 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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