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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. Accessed March 14, 2017.


  • Systemic fungal infection.


  • Systemic fungal infection caused by Coccidioides immitis


  • Arthroconidia inhaled after contact with contaminated soil.

  • Transformed into spherules, which reproduce and produce endospores.

  • Endospores released, stimulating acute inflammatory response.

    • Tissue infiltrated by mononuclear cells, resulting in granuloma formation.


  • 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.


  • No risk factors for primary disease, but factors that affect risk of subsequent dissemination of disease are summarized in Table 1.

TABLE 1.Factors for Severe, Disseminated Infection with Coccidioidomycosis


  • 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:

    • Fever.

    • Cough.

    • Headache.

    • Sore throat.

    • Myalgias.

    • Fatigue.

    • Fine, diffuse rash may appear during first few days of illness.

  • Chronic, persistent pneumonia or persistent pulmonary coccidioidomycosis (primary disease lasting >6 weeks)

    • Complicated by hemoptysis, pulmonary scarring, and formation of cavities or bronchopleural fistulas.

  • “Valley fever” (25% of patients)

    • Syndrome characterized by erythema nodosum and erythema multiforme of upper trunk and extremities in association with diffuse joint aches or fever.

  • Disseminated infection (<1% of patients)

    • Dissemination may occur to skin, lymph nodes, bone, meninges, spleen, liver, kidney, and adrenal gland.

      • Central nervous system (CNS) infection occurs in ~16% of patients with disseminated infection.

      • Symptoms subtle and nonspecific:


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