Source: Carver PL. Invasive fungal infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146073167. Accessed March 14, 2017.
Arthroconidia inhaled after contact with contaminated soil.
Transformed into spherules, which reproduce and produce endospores.
Endospores released, stimulating acute inflammatory response.
Coccidioides immitis grows in soil as mold.
Endemic regions encompass semiarid areas of southwestern United States from California to Texas, where there is scant annual rainfall, hot summers, and sandy, alkaline soil.
TABLE 1.Factors for Severe, Disseminated Infection with Coccidioidomycosis ||Download (.pdf) TABLE 1. Factors for Severe, Disseminated Infection with Coccidioidomycosis
|Race (Filipinos > African Americans > Native Americans > Hispanics > Asians) |
|Pregnancy (especially when infection is acquired or reactivated in the second or third trimester) |
|Compromised cellular immune system, including |
| AIDS patients |
| Patients receiving |
| Corticosteroids |
| Immunosuppressive agents |
| Chemotherapy |
|Male gender |
|Patients with B or AB blood types |
Spectrum of illnesses ranging from primary uncomplicated respiratory tract infection that resolves spontaneously to progressive pulmonary or disseminated infection.
60% of patients asymptomatic; 10- to 30-day incubation period.
40% of patients exhibit nonspecific symptoms that are often indistinguishable from ordinary upper respiratory infections.
Nonspecific symptoms that occur within 1–3 weeks after exposure:
Chronic, persistent pneumonia or persistent pulmonary coccidioidomycosis (primary disease lasting >6 weeks)
“Valley fever” (25% of patients)
Disseminated infection (<1% of patients)
Dissemination may occur to skin, lymph nodes, bone, meninges, spleen, liver, kidney, and adrenal gland.