Last reviewed: 5 Oct 2024
Last updated: 27 Feb 2024
Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
- fever
- cough
- rash
Full details
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
Full details
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
Full details
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
Full details
Tests to consider
- antigen testing
- polymerase chain reaction (PCR)
- lung biopsy
- lumbar puncture
- erythrocyte sedimentation rate
- CT chest
- bone scan
- MRI
Full details
Emerging tests
- lateral flow assay (LFA)
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
- 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- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer