| Subject | Contents |
| Definition | Coccidiodomycosis is a disease caused by the spores of the fungus, Coccidioides immitis .
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| Alternative Names | Coccidiosis; San Joaquin Valley Fever |
| Causes, incidence, and risk factors | Infection is caused by inhalation of the spores of the fungus, Coccidioides immitis , which is often found in desert regions. About 60% of infections cause no symptoms and are only recognized later by a positive coccidioidin skin test . In the remaining 40% of cases, symptoms range from mild to severe. People with a compromised immune system tend to have more serious infections. Individuals with AIDS are at higher risk for pulmonary (lung) coccidioidomycosis, as well as for the disseminated (spread to many body systems) and cutaneous (skin) forms of the disease.
The disease can have an acute , chronic , or disseminated form. Acute pulmonary coccidioidomycosis is almost always mild, with few or no symptoms, and resolves without treatment. The incubation period is 7 to 21 days. The incidence of acute coccidioidomycosis is rare. In any given year, about 3% of people who live in an area where coccidiomycosis is commonly seen will develop the disease.
Chronic pulmonary coccidioidomycosis can develop 20 or more years after initial infection which may not have been recognized, diagnosed, or treated at the time. Infections (lung abscesses ) can form and rupture releasing pus ( empyema ) between the lungs and ribs (pleural space). This disorder is even less common than the acute form, however.
In disseminated disease, spread of infection to the bones, lungs, liver, meninges, brain, skin, heart, and pericardium (sac around the heart) may take place. Meningitis occurs in 30 to 50% of cases of disseminated disease. The course of the disease may be rapid for immunosuppressed patients. |
| Symptoms | Any of the following may be symptoms: CoughChest pain , varies from mild sense of constriction to severe Fever Chills Night sweats HeadacheMuscle stiffness Muscle achesJoint stiffnessNeck stiffness or shoulder stiffnessRash , may be painful, red, on lower legs ( erythema nodosum ) Blood-tinged sputum Loss of appetiteWeight lossWheezingSweating, excessiveChange in mental statusSensitivity to light Additional symptoms that may be associated with this disease: Joint swellingJoint painArthritisAnkle, feet, and leg swelling See also skin lesion of coccidioidomycosis . |
| Signs and tests | Sputum smear (KOH test)Sputum culture Serum coccidioides complement fixation titerCBC with differential shows elevated eosinophilsChest X-rayCoccidioidin or spherulin skin test |
| Treatment | The acute disease almost always goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended. Disseminated or severe disease should be treated with amphotericin B, ketoconazole fluconazole, or itraconazole. |
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| Expectations (prognosis) | The outcome in acute disease is likely to be good. With treatment, for chronic or severe disease, the outcome is usually good (although relapses may occur). People with disseminated disease have a high death rate.
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| Complications | Pleural effusion Relapse of infection Spread of the infection throughout the body Complications from medications. In particular, amphotericin B may cause fever, chills, and nausea while it is being given, and may cause abnormal kidney tests after many doses. |
| Calling your health care provider | Call for an appointment with your health care provider if symptoms develop that are suggestive of coccidioidomycosis. |
| Prevention | General maintenance of good health will limit the disease to a benign pulmonary form. Prevention of AIDS or other causes of damage to the immune system will generally prevent the more severe forms of the disease.
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