Coccidioidomycosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Apr 2025

Last updated: 27 Feb 2024

Coccidioidomycosis is a fungal infection caused by the endemic fungus Coccidioides species.

Most symptomatic coccidioidal infections are mild to severe episodes of pneumonia.

Extrapulmonary infection in sites such as skin, soft tissue, or skeletal or central nervous system occurs infrequently.

Common symptoms include fever, headache, dry cough, shortness of breath, inspiratory chest pain, 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.

Definition

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

presence of risk factors
asymptomatic
fever
cough
rash

Full details

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

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 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

Full details

Investigations 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 (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)

pregnant

Contributors

Authors

Janis E. Blair, MD

Professor of Medicine

Mayo Clinic College of Medicine and Sciences

Rochester

Division of Infectious Diseases

Mayo Clinic

Phoenix

Disclosures

JEB declares that she has no competing interests.

Peer reviewers

Susan Hoover, MD

Infectious Diseases Clinic

Sanford Health Sioux Falls

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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. 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
- Non-tuberculous pulmonary mycobacterial infections
- Community-acquired pneumonia
More Differentials
Guidelines
- Clinical testing guidance for coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia
- CDC Yellow Book: health information for international travel - coccidioidomycosis/valley fever
More Guidelines
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Coccidioidomycosis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

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)

pregnant

Contributors

Authors

Janis E. Blair, MD

Disclosures

Peer reviewers

Susan Hoover, MD

Disclosures

Astrid Mayr, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice