View source for Coccidioidomycosis

==Background==
*Fungal infection caused by ''Coccidioides immitis'' and ''C. posadasii''<ref>Galgiani JN, et al. 2016 IDSA Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis. 2016;63(6):e112-e146. PMID 27470238</ref>
*Organisms found in soil in arid climates of southwestern US and nearby areas
*Transmitted by inhalation of airborne spores
*Also known as Valley Fever

==Clinical Features==
*Often asymptomatic
*Most commonly affects lungs
*Mild ILI 1-4 weeks after exposure
**[[Fever]]
**[[Sore throat]]
**Cough
**[[Headache]]
**Fatigue
**Pleuritic chest pain
*More severe presentation
**[[Fever]]
**[[Arthralgias]]
**[[Erythema nodosum]] or [[erythema multiforme]]
**[[Chest pain]]
*Rarely, respiratory failure
*Disseminated disease, more common in immunosuppressed
**Dramatic sweats
**Dyspnea at rest
**[[Fever]]
**Weight loss
**50% develop [[meningitis]]

==Differential Diagnosis==
*[[Acute respiratory distress syndrome]]
*[[Blastomycosis]]
*Enteropathic arthropathies
*[[Eosinophilic pneumonia]]
*[[Histoplasmosis]]
*[[Lung abscess]]
*Lung cancer
*[[Lymphoma]]
*Myelophthisic anemia
*Old granuloma
*[[Paracoccidioidomycosis]]
*[[Pericarditis]] (acute or chronic)
*[[Pneumocystis jirovecii pneumonia]]
*[[Sarcoidosis]]
*Solitary pulmonary nodule
*[[TB]]

==Evaluation==
===Workup===
*Basic workup
**Typically normal WBC count or mild lymphocytosis, monocytosis, and/or [[eosinophilia]] (>5%) 
**Elevated ESR
**[[CXR]]
**[[LP]] if suspect [[meningitis]]
*Special testing
**Immunoglobulin testing
**Culture
**PCR testing
**Skin testing

==Management==
*Often self-limited mild disease not requiring treatment
*[[Azoles]] first line
*Treatment options
**[[Itraconazole]] - 200mg 2-3 times/day orally
**[[Fluconazole]] - 400-800mg/day orally or IV
**[[Ketoconazole]] - 400mg/day orally
**[[Amphotericin B]] deoxycholate - 0.5-1.5mg/kg/day IV
**Lipid formulations of [[amphotericin B]] - 2-5mg/kg/day IV

==Disposition==
*

==See Also==
*[[Fungal infections]]
*[[Antifungals]]

==References==
<References/>

[[Category:ID]]