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Coccidioidomycosis - acute pulmonary


Coccidioidomycosis is an infection caused by inhalation of spores of Coccidioides immitis, a fungus found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

Causes, incidence, and risk factors

Coccioioides infection begins in the lungs, following inhalation of the spores. About 60% of infections resolve without ever causing symptoms and are only recognized by a positive coccidioidin skin test .

In the remaining 40% of infections, symptoms range from mild (such as cold-like or flu-like symptoms) to severe, such as pneumonia. (See coccidioidomycosis .) In less than one percent of infections, widespread disease occurs when the fungus spreads from the lungs through the blood stream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.

Individuals of African or Philippine descent and people with a weak immune system, such as patients with AIDS or diabetes or those taking immunosuppressive medications, can develop more serious infections. Occasionally the acute infection can develop into a chronic pulmonary (lung) disease or can "reactivate" after a long latent period.

A history of travel to an endemic region is the key to suspecting coccidioidal infection. Arizona, California (especially San Joaquin Valley), and to a lesser extent western Texas are endemic regions in the USA.


  • Cough
  • Sputum or phlegm
  • Chest pain , varies from mild sense of constriction to severe
  • Fever
  • Chills
  • Night sweats
  • Headache
  • Muscle stiffness
  • Muscle aches
  • Joint stiffness
  • Rash , may be painful, red, on lower legs ( erythema nodosum )
  • Weight loss
  • Lymph node swelling

See also Skin lesion of coccidioidomycosis .

Signs and tests

  • Sputum smear ( KOH test or Papanicolaou stain)
  • Biopsy of lymph node or lung
  • Sputum culture
  • Serum coccidioides complement fixation titer
  • CBC with differential
  • Chest X-ray
  • Coccidioidin or spherulin skin test


The acute disease is almost always benign and goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.

In severe forms of the disease ( disseminated coccidioidomycosis ), antifungal treatment with amphotericin B, fluconazole, or itraconazole can be used. The best length of treatment with these medications has not been determined for this disease.

Expectations (prognosis)

The outlook in milder cases is usually good. Disseminated coccidioidomycosis can be serious, particularly in people with weakened immune systems.


  • Coccidioidomycosis - chronic pulmonary
  • Coccidioidomycosis - disseminated

Calling your health care provider

  • Symptoms develop that suggest coccidioidomycosis
  • Symptoms worsen or do not improve with treatment
  • New symptoms develop


Avoiding travel to regions where this fungus is found may prevent risk of developing this disorder. However, this is not practical or possible for many people. It may be prudent to try to avoid contact with soil in these regions if you have a weakened immune system due to HIV or other conditions.

Update Date: 11/17/2002

David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT