Coccidioidomycosis

Individuals in certain occupations are more frequently exposed to the contaminated soil (dust) and therefore are more likely to be infected with Coccidioides immitis. Among them agricultural and construction workers or military personnel, geologists, archaeologists, etc. are most frequently affected. It is well known that the fungus poses a health hazard to hospital and medical laboratory workers even outside the endemic regions (Johnson 1981). 

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A marked improvement is generally noted after 4—8 weeks of treatment. Treatment is often continued until a total dose of 3 g is reached. In the case of coccidioidomycosis, for example, treatment with 0.4—0.8 mg/kg/d may last months. The polyene is adrninistered intrathecaHy to treat Coccidioides meningitis. However, the results are only moderate. It is very important to check renal and hepatic function during treatment with amphotericin B. 

Fungal (histoplasmosis, coccidioidomycosis, cryptococcosis, Blastomyces dermatitidis infection)... 

The patient s serum titer for coccidioidomycosis returns as greater than 1 32. Based on the information presented, select an appropriate treatment plan for the patient s coccidioidomycosis. 

Response to antifungal therapy may be slow in patients with a prolonged history of infection or severe manifestations. However, gradual improvements in symptoms and reduction in fever are indicators of response to antifungal therapy. For histoplasmosis and coccidioidomycosis, decreasing antigen titers are also indicative of response to antifungal therapy.1... 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Until 2002, C. posadasii was believed to be a non-California variant of C. immitis. The two species can only be distinguished by genetic analysis and by the fact that C. posadasii grows more slowly in the presence of high salt concentrations. There is no apparent difference in pathogenicity between the two species. For more information on coccidioidomycosis, the disease caused by these two fungi, see C. immitis (C20-A002). 

Suggested Alternatives for Differential Diagnosis Blastomycosis, coccidioidomycosis, aspergillosis, pneumonia, respiratory distress syndrome, mediastinal cysts, mycoplasma infections, Pancoast syndrome, sarcoidosis, tuberculosis, lung abscess, lung cancer, lymphoma. 

Coccidioidomycosis is caused by infection with Coccidioides immitis. The endemic regions encompass the semi-arid regions 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. 

Therapy of coccidioidomycosis is difficult, and the results are unpredictable. Only 5% of infected persons require therapy. Candidates for therapy include those with severe primary pulmonary infection or concurrent risk factors (e.g., human immunodeficiency virus infection, organ transplant, or high doses of glucocorticoids), particularly patients with high complement fixation antibody titers in whom dissemination is likely. 

Specific antifungals (and their usual dosages) for the treatment of coccidioidomycosis include amphotericin B IV (0.5 to 1.5 mg/kg/day), ketocona-zole (400 mg orally daily), IV or oral fluconazole (usually 400 to 800 mg daily, although dosages as high as 1,200 mg/day have been utilized without complications), and itraconazole (200 to 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. 

Amphotericin B is generally preferred as initial therapy in patients with rapidly progressive disease, whereas azoles are generally preferred in patients with subacute or chronic presentations. Lipid formulations of amphotericin B have not been extensively studied for coccidioidomycosis but can offer a means of giving more drug with less toxicity. Treatments for primary respiratory disease (mainly symptomatic patients) are 3- to 6-month courses of therapy. 

Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (duration >1 month) Cytomegalovirus disease (other than liver, spleen, or nodes)... 

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