Version June 2024
| Incubation period | Common clinical findings | Diagnosis | Treatment | Potential complications | |
| Asymptomatic infection | Unknown | None | Serologic testing that is performed as part of screening (eg, immunocompromised hosts) or as part of the evaluation of a pulmonary lesion. | Not indicated* | In rare cases, there may be pulmonary sequelae or reactivation in the setting of immunosuppression. |
| Primary coccidioidal pneumonia | Symptoms occur approximately 7 to 21 days after an exposure, which may or may not be apparent. | Patients can be asymptomatic or develop the following:
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| Most immunocompetent patients with primary coccidioidal infection do not require antifungal therapy. However, treatment should be administered to those with moderate or severe disease and those at high risk for developing more serious/complicated disease.Δ | Complications can occur regardless of treatment:
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| Extrathoracic coccidioidomycosis | |||||
| Nonmeningeal | Extrathoracic lesions typically become evident within weeks to months after the initial exposure. However, in patients who have received early antifungal treatment, there are reports of delayed presentation of dissemination. | Most common sites are:
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| Nearly all patients with disseminated infections should be treated with antifungal therapy; an exception may be children with isolated skin lesions. Surgical debridement or stabilization is important, and even critical, as adjunctive treatment in some cases. | If left untreated, patients can develop severe infection, including limb-threatening skeletal disease, vertebral infection causing cord compromise, and airway obstruction due to paratracheal abscess. |
| Meningitis | Infection spreads hematogenously to establish a tissue-destructive lesion in the meninges. Symptoms typically develop within weeks to months after primary infection. Occasionally, intervals as long as 1 to 2 years have been noted. | The most common symptom of coccidioidal meningitis is persistent headache that is present in approximately 75% of patients. Cognitive decline may also be seen. Nuchal rigidity is infrequent. | The diagnosis of coccidioidal meningitis requires a CSF sample. Lymphocytic pleocytosis, increased protein, and hypoglycorrhachia are usually present. The diagnosis is usually established by identifying anticoccidioidal antibodies in the CSF. Isolating Coccidioides spp from CSF is uncommon. | All patients with meningitis should be treated with antifungal therapy. High-dose oral fluconazole is the drug of choice for the initial treatment of coccidioidal meningitis. | Patients with increased ICP at the time of diagnosis can be managed with medical therapy and repeated lumbar punctures. However, most patients who develop hydrocephalus require a shunt for decompression. |
EIA: enzyme immune assay; Ig: immunoglobulin; CSF: cerebrospinal fluid; ICP: intracranial pressure; TNF: tumor necrosis factor.
* Prophylactic treatment is typically indicated if asymptomatic infection is identified through screening in patients undergoing solid organ or hematopoietic cell transplant and in those initiating anti-TNF therapy. Refer to the UpToDate topic that discusses coccidioidomycosis in immunocompromised patients.
¶ In patients with early disease, repeated serologic testing may be needed, since antibodies can take weeks to develop. Attempting to identify the organism via direct examination or through culture can also be useful in this setting, especially in those with severe disease.
Δ Risk factors for developing serious and/or complicated disease include: immunocompromised patients, pregnant individuals, individuals of African or Filipino descent, patients with diabetes, and frail older adults. Refer to table on treatment of primary pulmonary coccidioidomycosis for details on approach to treatment.
◊ Coccidioides can be identified either by visualizing spherules in histopathology specimens or by culture of a lesion in the affected organ.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
