Coccidioidomycosis
Background
- Fungal infection caused by Coccidioides immitis and C. posadasii
- Organisms found in soil in arid climates of southwestern US and nearby areas
- Transmitted by inhalation of airborne spores
- Also known as Valley Fever
Clinical Features
- Often asymptomatic
- Most commonly affects lungs
- Mild ILI 1-4 weeks after exposure
- Fever
- Sore throat
- Cough
- Headache
- Fatigue
- Pleuritic chest pain
- More severe presentation
- Rarely, respiratory failure
- Disseminated disease, more common in immunosuppressed
- Dramatic sweats
- Dyspnea at rest
- Fever
- Weight loss
- 50% develop meningitis
Differential Diagnosis
- Acute respiratory distress syndrome
- Blastomycosis
- Enteropathic arthropathies
- Eosinophilic pneumonia
- Histoplasmosis
- Lung abscess
- Lung cancer
- Lymphoma
- Myelophthisic anemia
- Old granuloma
- Paracoccidioidomycosis
- Pericarditis (acute or chronic)
- Pneumocystis jirovecii pneumonia
- Sarcoidosis
- Solitary pulmonary nodule
- TB
Evaluation
Workup
- Basic workup
- Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%)
- Elevated ESR
- CXR
- LP if suspect meningitis
- Special testing
- Immunoglobulin testing
- Culture
- PCR testing
- Skin testing
Management
- Often self-limited mild disease not requiring treatment
- Azoles first line
- Treatment options
- Itraconazole - 200mg 2-3 times/day orally
- Fluconazole - 400-800mg/day orally or IV
- Ketoconazole - 400mg/day orally
- Amphotericin B deoxycholate - 0.5-1.5mg/kg/day IV
- Lipid formulations of amphotericin B - 2-5mg/kg/day IV