Coccidioidomycosis

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Presentation :

Pathophysiology :

• There are two species: C. immitis refers to isolates from California, and C. posadasii refers to isolates from all other endemic areas, including Arizona, New Mexico, western Texas, northern Mexico, and parts of Central and South America.
• Infection is usually acquired by inhalation of aerosolized arthroconidia; the fungus then begins its dimorphic change in the lungs and becomes a yeast cell

Diagnostic Testing:

• Diagnosis is straightforward in endemic areas and usually is based on clinical manifestations and confirmatory testing by a mycologic culture of affected tissue, histopathologic evaluation of tissue, and serology for Coccidioides antibodies.

Treatment :

• Fluconazole is the first-line treatment for symptomatic infection. In patients with meningitis, fluconazole is continued for life. In patients who do not respond to azoles, intrathecal amphotericin B may be an alternative.

Prognosis:

• In endemic areas, the annual risk of infection is approximately 3% for most persons, although the risk of infection (and dissemination) is greater in those who are pregnant and those who are younger than 5 years or older than 50 years.

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