5.4 SFGH am report pearls: coccidioidomycosis


  • clinical manifestations: often 7-21 days after exposure, although can reactivate later
    • asymptomatic in ~50%, CAP, arthralgias, e nodosum, e multiforme
  • diagnosis:
    • keep in mind epidemiology
    • cocci immunodiffusion (IgM vs IgG) is qualitative
    • Cocci complement fixation is quantitative and correlates with disease activity
      • Titer >1:16 = aggressive pulmonary disease OR disseminated disease
    • additional testing options include culture and PCR on fixed tissue
    • About 25% of patients with cocci will have >5% peripheral eosinophilia
  • Treatment is not always necessary, but should treat if >10% wt loss, persistent night sweats x 3wks, complement fixation titers >1:16, inability to work, HIV, or sx > 2 mos
    • Individuals of African or Philippine descent have an increased risk of extrapulmonary complications
  • Treatment is fluconazole or itraconazole x 3-6mos
  • Saubolle MA, McKellar PP, Sussland D. Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. J Clin Microbiol 2007; 45:26.
  • Pappagianis D, Lindsay S, Beall S, Williams P. Ethnic background and the clinical course of coccidioidomycosis. Am Rev Respir Dis 1979; 120:959.
  • Galgiani JN, Ampel NM, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis 2005; 41:1217.
  • Evernote link: http://www.evernote.com/l/AoNVmLN-TGBK4KBmmLlBeNVBI-1YzvA-1NE/

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