Coccidioidomycosis
Not yet clinically reviewed
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Introduction
- Coccidioidomycosis is caused by infection with Coccidioides immitis. The endemic regions encompass the semiarid areas of the southwestern United States from California to Texas, known as the Lower Sonoran Zone. It encompasses a spectrum of illnesses ranging from primary uncomplicated respiratory tract infection that resolves spontaneously to progressive pulmonary or disseminated infection.
Clinical Presentation and Diagnosis
- Approximately 60% of those infected are asymptomatic or have nonspecific symptoms that are often indistinguishable from those of ordinary upper respiratory infections, including fever, cough, headache, sore throat, myalgias, and fatigue. A fine, diffuse rash may appear during the first few days of illness. Chronic, persistent pneumonia or persistent pulmonary coccidioidomycosis (primary disease lasting >6 weeks) is complicated by hemoptysis, pulmonary scarring, and the formation of cavities or bronchopleural fistulas.
- Disseminated infection occurs in less than 1% of infected patients. Dissemination may occur to the skin, lymph nodes, bone, meninges, spleen, liver, kidney, and adrenal gland. CNS infection occurs in ~16% of patients with disseminated infection.
- The diagnoses of coccidioidomycosis generally utilize identification or recovery of Coccidioides spp. from clinical specimens and detection of specific anticoccidioidal antibodies in serum or other body fluids.
Treatment
- Therapy of coccidioidomycosis is difficult, and the results are unpredictable. Only 5% of infected persons require therapy.
Specific antifungals (and their usual dosages) for the treatment of coccidioidomycosis include amphotericin B IV (0.5–1.5 mg/kg/day), ketoconazole (400 mg orally daily), IV or oral fluconazole (usually 400–800 mg daily, although dosages as high as 1200 mg/day have been used without complications), and itraconazole (200–300 mg orally twice daily as either capsules or solution). If itraconazole is used, measurement of serum concentrations may be helpful to ascertain whether oral bioavailability is adequate.