Coccidioidomycosis Differential Diagnoses

  • Author: Duane R Hospenthal, MD, PhD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 8, 2011
 
 

Diagnostic Considerations

A common pitfall is mistaking viral meningitis for coccidioidal meningitis in patients with meningitis and lymphocytic pleocytosis. The patient's travel history and area of residence have a major role in leading the clinician to the correct diagnosis. Findings of eosinophils in the CSF or hypoglycorrhachia are important. The progressive nature of the disease is inconsistent with a viral etiology.

The differential diagnoses of erythema nodosum are extensive. Coccidioidomycosis is perhaps one of the most significant associated conditions, and once again, the patient's travel history and area of residence are important. Patients with erythema nodosum generally have a benign course.

Other problems to be considered in the differential diagnosis of coccidioidomycosis include the following:

  • Acute respiratory distress syndrome
  • Blastomycosis
  • Enteropathic arthropathies
  • Eosinophilic Pneumonia
  • Histoplasmosis
  • Lung abscess
  • Lung cancer
  • Lymphoma
  • Myelophthisic anemia
  • Old granuloma
  • Paracoccidioidomycosis
  • Pericarditis (acute or chronic)
  • Sarcoidosis
  • Solitary pulmonary nodule

The differential diagnosis of cystic lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Blebs
  • Bullae
  • Pneumatoceles
  • Congenital cystic lesions
  • Traumatic lesions
  • Pneumocystis jiroveci pneumonia
  • Hydatid disease

The differential diagnosis of focal or multifocal cavitary lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Neoplasms (eg, bronchogenic carcinoma, lymphoma)
  • Immunologic disorders such as Wegener granulomatosis and rheumatoid nodule
  • Pulmonary infarct
  • Septic embolism
  • Lymphocytic interstitial pneumonia
  • Localized bronchiectasis

The differential diagnosis of diffuse involvement with cystic or cavitary lesions seen on chest imaging studies in patients with possible coccidioidomycosis is as follows:

  • Pulmonary lymphangioleiomyomatosis
  • Pulmonary Langerhans cell histiocytosis
  • Honeycomb lung associated with advanced fibrosis
  • Diffuse bronchiectasis
  • Metastatic disease

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Duane R Hospenthal, MD, PhD  Professor of Medicine, Uniformed Services University of the Health Sciences; Physician, Infectious Disease Service, San Antonio Military Medical Center (formerly Brooke Army Medical Center)

Duane R Hospenthal, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Society for Human and Animal Mycology, International Society for Infectious Diseases, International Society of Travel Medicine, and Medical Mycology Society of the Americas

Disclosure: Nothing to disclose.

Coauthor(s)

Kelley Struble, DO  Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Disclosure: Nothing to disclose.

Ana Paula Oppenheimer, MD, MPH  Fellow, Section of Infectious Diseases, Wake Forest University Baptist Medical Center

Disclosure: Nothing to disclose.

Edward L Arsura, MD  Chair, Department of Medicine, Chief Medical Officer, Richmond University Medical Center

Edward L Arsura, MD is a member of the following medical societies: American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Heart Association, American Medical Association, California Medical Association, Society of General Internal Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases,Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Archana Chatterjee, MD, PhD Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Michele M Cheung, MD Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California, San Francisco, School of Medicine

Michele M Cheung, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

John E Cho, MD Staff Physician, Providence Tarzana Medical Center

John E Cho, MD is a member of the following medical societies: American College of Chest Physicians, California Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

James de la Torre, MD Resident Physician, Department of Emergency Medicine, LAC+USC Medical Center

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Joseph Kim, MD Chairman, Department of Emergency Medicine, Western Medical Center; Clinical Instructor, University of California, Irvine, School of Medicine

Disclosure: Nothing to disclose.

Zab Mosenifar, MD Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

Catherine O'Keefe, DNP, APRN Assistant Professor of Nursing and Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Michael Peterson, MD Chief of Medicine, Vice-Chair of Medicine, University of California, San Francisco, School of Medicine; Endowed Professor of Medicine, University of California, San Francisco-Fresno, School of Medicine

Michael Peterson, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Allison J Richard, MD Assistant Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California; Associate Director, Division of International Medicine, Attending Physician, Department of Emergency Medicine, LAC+USC Medical Center

Disclosure: Nothing to disclose.

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American Association for Respiratory Care, American College of Chest Physicians, American College of Physicians, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Peggy Weintrub, MD Chief, Division of Pediatric Infectious Diseases, Clinical Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine

Peggy Weintrub, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

References

  1. [Best Evidence] Goegebuer T, Nackaerts K, Himpe U, Verbeken E, Lagrou K. Coccidioidomycosis: an unexpected diagnosis in a patient with persistent cough. Acta Clin Belg. May-Jun 2009;64(3):235-8. [Medline].

  2. American Academy of Pediatrics. Red Book: 2009 Report of the Committee on Infectious Diseases. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Coccidioidomycosis. 28th ed. ElkGrove Village, IL: American Academy of Pediatrics; 2009:266-268.

  3. Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA, et al. Coccidioidomycosis. Clin Infect Dis. Nov 1 2005;41(9):1217-23. [Medline].

  4. Kleiman MB. Coccidioides immitis and Coccidiodes posadasii (Coccidiodomycosis). In: Long SS, Pickering LK, Prober CG. Principles and practice of pediatric infectious disease. 3rd ed. Philadelphia: Churchill Livingstone; 2008:1213-1217.

  5. Kwok HK, Chan JW, Li IW, Chu SY, Lam CW. Coccidioidomycosis as a rare cause of pneumonia in non-endemic areas: a short exposure history should not be ignored. Respirology. May 2009;14(4):617-20. [Medline].

  6. Parish JM, Blair JE. Coccidioidomycosis. Mayo Clin Proc. Mar 2008;83(3):343-48; quiz 348-9. [Medline].

  7. Anstead GM, Graybill JR. Coccidiodomycosis. Infect Dis Clin N Am. 2006;20:621-643.

  8. Spinello IM, Munoz A, Johnson RH. Pulmonary coccidioidomycosis. Semin Respir Crit Care Med. Apr 2008;29(2):166-73. [Medline].

  9. Ampel NM. Coccidioidomycosis: a review of recent advances. Clin Chest Med. Jun 2009;30(2):241-51, v. [Medline].

  10. Galgiani JN. Coccidioides Species. In: Principles and Practices of Infectious Diseases, Mandell, Douglas and Bennet. Vol 2. 6th ed. Elsevier; 2005:3040-51.

  11. Gaidici A, Saubolle MA. Transmission of coccidioidomycosis to a human via a cat bite. J Clin Microbiol. Feb 2009;47(2):505-6. [Medline]. [Full Text].

  12. Centers for Disease Control [CDC]. Increase in Coccidioidomycosis - California, 2000-2007. MMWR Morb Mortal Wkly Rep. Feb 13 2009;58(5):105-9. [Medline].

  13. Kim MM, Blair JE, Carey EJ, Wu Q, Smilack JD. Coccidioidal pneumonia, Phoenix, Arizona, USA, 2000-2004. Emerg Infect Dis. Mar 2009;15(3):397-401. [Medline]. [Full Text].

  14. de Aguiar Cordeiro R, Brilhante RS, Rocha MF, et al. Twelve years of coccidioidomycosis in Ceara State, Northeast Brazil: epidemiologic and diagnostic aspects. Diagn Microbiol Infect Dis. 2009.

  15. Togashi RH, Aguiar FM, Ferreira DB, Moura CM, Sales MT, Rios NX. Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil. J Bras Pneumol. Mar 2009;35(3):275-9. [Medline].

  16. CDC. From the Centers for Disease Control and Prevention. Coccidioidomycosis following the Northridge earthquake--California, 1994. JAMA. Jun 8 1994;271(22):1735. [Medline].

  17. Schneider E, Hajjeh RA, Spiegel RA, et al. A coccidioidomycosis outbreak following the Northridge, Calif, earthquake. JAMA. Mar 19 1997;277(11):904-8. [Medline].

  18. Ampel NM, Mosley DG, England B, Vertz PD, Komatsu K, Hajjeh RA. Coccidioidomycosis in Arizona: increase in incidence from 1990 to 1995. Clin Infect Dis. Dec 1998;27(6):1528-30. [Medline].

  19. Increase in Coccidioidomycosis - California, 2000-2007. MMWR Morb Mortal Wkly Rep. Feb 13 2009;58(5):105-9. [Medline].

  20. Park BJ, Sigel K, Vaz, V et al. An epidemic of coccidiodomycosis in Arizona associated with climatic changes, 1998-2001. J Infect Dis. 2006;191:1981-7.

  21. Stern NG, Galgiani JN. Coccidioidomycosis among scholarship athletes and other college students, Arizona, USA. Emerg Infect Dis. Feb 2010;16(2):321-3. [Medline]. [Full Text].

  22. Negroni R. [Historical evolution of some clinical and epidemiological knowledge of coccidioidomycosis in the Americas]. Rev Argent Microbiol. Oct-Dec 2008;40(4):246-56. [Medline].

  23. Buijze GA, Kok P, Botha-Scheepers SA, Smith SJ, Sleeboom HP. Fungal disease of the Western hemisphere: a patient with coccidioidomycosis. Eur J Intern Med. May 2009;20(3):319-22. [Medline].

  24. Holemans X, Levecque P, Despontin K, Maton JP. [First report of coccidioidomycosis associated with Sweet syndrome]. Presse Med. Jul 1 2000;29(23):1282-4. [Medline].

  25. Batura-Gabryel H, Brajer B. Coccidioidomycosis in a 38-year-old man: a case report. Pol Arch Med Wewn. Jun 2008;118(6):387-90. [Medline].

  26. Kojima T, Takase K, Nakaya J, Igarashi K, Yamaguchi W, Kaizaki Y. [Case of pulmonary coccidioidomycosis presented with multiple infiltrative opacities]. Nihon Kokyuki Gakkai Zasshi. May 2008;46(5):390-4. [Medline].

  27. Lan F, Tong YZ, Huang H, Xiong WN, Xu YJ, Xiong SD. Primary pulmonary coccidioidomycosis in China. Respirology. May 2010;15(4):722-5. [Medline].

  28. Baird RW, Teichtahl H, Ednie HM, Tasiopoulos A, Ryanf N, Gee D. A fluffy white traveller: imported Coccidiodes immitis infection in an Australian tourist. Pathology. Feb 1999;31(1):47-50. [Medline].

  29. CDC. Increase in coccidioidomycosis--Arizona, 1998-2001. MMWR Morb Mortal Wkly Rep. Feb 14 2003;52(6):109-12. [Medline].

  30. Louie L, Ng S, Hajjeh R, et al. Influence of host genetics on the severity of coccidioidomycosis. Emerg Infect Dis. Sep-Oct 1999;5(5):672-80. [Medline]. [Full Text].

  31. Galgiani JN. Primary Coccidioidal Infection. UpToDate [serial online]. January 18, 2008;Accessed 2008. Available at http://www.uptodate.com/patients/content/topic.do?topicKey=~cxmxdubHE8bOu_.

  32. Johnson RH, Caldwell JW, Welch G. The great Coccidioidomycosis epidemic: Clinical Features. In: Einstein HE, Catanzaro A, eds. Proceedings of Fifth International Conference. Bethesda, MD: 1996:77-87.

  33. Spinello IM, Johnson RH, Baqi S. Coccidioidomycosis and pregnancy: a review. Ann N Y Acad Sci. Sep 2007;1111:358-64. [Medline].

  34. Hooper JE, Lu Q, Pepkowitz SH. Disseminated coccidioidomycosis in pregnancy. Arch Pathol Lab Med. Apr 2007;131(4):652-5. [Medline].

  35. Bergstrom L, Yocum DE, Ampel NM, Villanueva I, Lisse J, Gluck O. Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists. Arthritis Rheum. Jun 2004;50(6):1959-66. [Medline].

  36. Einstein HE, Johnson RH. Coccidioidomycosis: new aspects of epidemiology and therapy. Clin Infect Dis. Mar 1993;16(3):349-54. [Medline].

  37. Richardson MD, Warnock DW. Coccidioidomycosis. In: Fungal Infection Diagnosis and Management. Blackwell Scientific Publication; 1993:134-42.

  38. Increase in Coccidioidomycosis - California, 2000-2007. MMWR Morb Mortal Wkly Rep. Feb 13 2009;58(5):105-9. [Medline].

  39. Blair JE. State-of-the-art treatment of coccidioidomycosis skeletal infections. Ann N.Y. Acad Sci. 2007;1111:421-433.

  40. Crum-Cianflone NF, Truett AA, Teneza-Mora N, et al. Unusual presentations of coccidioidomycosis: a case series and review of the literature. Medicine (Baltimore). Sep 2006;85(5):263-77. [Medline].

  41. Arsura EL, Bobba RK, Reddy CM. Coccidioidal pericarditis: a case presentation and review of the literature. Int J Infect Dis. Mar 2005;9(2):104-9. [Medline].

  42. Vasconcelos-Santos DV, Lim JI, Rao NA. Chronic coccidioidomycosis endophthalmitis without concomitant systemic involvement: a clinicopathological case report. Ophthalmology. Sep 2010;117(9):1839-42. [Medline].

  43. Blair JE, Mayer AP, Currier J, Files JA, Wu Q. Coccidioidomycosis in elderly persons. Clin Infect Dis. Dec 15 2008;47(12):1513-8. [Medline].

  44. Blair JE. Coccidioidal meningitis: update on epidemiology, clinical features, diagnosis, and management. Curr Infect Dis Rep. Jul 2009;11(4):289-95. [Medline].

  45. Keckich DW, Blair JE, Vikram HR. Coccidioides fungemia in six patients, with a review of the literature. Mycopathologia. Aug 2010;170(2):107-15. [Medline].

  46. Masannat FY, Ampel NM. Coccidioidomycosis in patients with HIV-1 infection in the era of potent antiretroviral therapy. Clin Infect Dis. Jan 1 2010;50(1):1-7. [Medline].

  47. Ampel NM, Dionne SO, Giblin A, Podany AB, Galgiani J. Mannose-binding lectin serum levels are low in persons with clinically active coccidioidomycosis. Mycopathologia. Apr 2009;167(4):173-80. [Medline].

  48. Durkin M, Connolly P, Kuberski T, et al. Diagnosis of coccidioidomycosis with use of the Coccidioides antigen enzyme immunoassay. Clin Infect Dis. Oct 15 2008;47(8):e69-73. [Medline].

  49. Blair JE, Currier JT. Significance of isolated positive IgM serologic results by enzyme immunoassay for coccidioidomycosis. Mycopathologia. Aug 2008;166(2):77-82. [Medline].

  50. Bialek R, González GM, Begerow D, Zelck UE. Coccidioidomycosis and blastomycosis: advances in molecular diagnosis. FEMS Immunol Med Microbiol. Sep 1 2005;45(3):355-60. [Medline].

  51. Vucicevic D, Blair JE, Binnicker MJ, McCullough AE, Kusne S, Vikram HR. The Utility of Coccidioides Polymerase Chain Reaction Testing in the Clinical Setting. Mycopathologia. Jun 10 2010;[Medline].

  52. de Aguiar Cordeiro R, Nogueira Brilhante RS, Gadelha Rocha MF, Araujo Moura FE, Pires de Camargo Z, Costa Sidrim JJ. Rapid diagnosis of coccidioidomycosis by nested PCR assay of sputum. Clin Microbiol Infect. Apr 2007;13(4):449-51. [Medline].

  53. Bialek R, Kern J, Herrmann T, Tijerina R, Cecenas L, Reischl U, et al. PCR assays for identification of Coccidioides posadasii based on the nucleotide sequence of the antigen 2/proline-rich antigen. J Clin Microbiol. Feb 2004;42(2):778-83. [Medline].

  54. Binnicker MJ, Buckwalter SP, Eisberner JJ, Stewart RA, McCullough AE, Wohlfiel SL, et al. Detection of Coccidioides species in clinical specimens by real-time PCR. J Clin Microbiol. Jan 2007;45(1):173-8. [Medline].

  55. Tkachenko GA, Grishina MA, Antonov VA, Savchenko SS, Zamaraev VS, Lesovoi VS, et al. [Identification of the agents of coccidioidomycosis using polymerase chain reaction]. Mol Gen Mikrobiol Virusol. 2007;25-31. [Medline].

  56. Ampel NM, Hector RF, Lindan CP, Rutherford GW. An archived lot of coccidioidin induces specific coccidioidal delayed-type hypersensitivity and correlates with in vitro assays of coccidioidal cellular immune response. Mycopathologia. Feb 2006;161(2):67-72. [Medline].

  57. Adam RD, Elliott SP, Taljanovic MS. The spectrum and presentation of disseminated coccidioidomycosis. Am J Med. Aug 2009;122(8):770-7. [Medline].

  58. Blair JE. State-of-the-art treatment of coccidioidomycosis skeletal infections. Ann N Y Acad Sci. Sep 2007;1111:422-33. [Medline].

  59. Naidu VG, Tammineni AK, Biscopink RJ, Davis TL, Veerabagu MP. Coccidioides immitis and Mycobacterium tuberculosis diagnosed by endoscopic ultrasound. J S C Med Assoc. Feb 2009;105(1):4-7. [Medline].

  60. Valdivia L, Nix D, Wright M, et al. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis. Jun 2006;12(6):958-62. [Medline].

  61. Berg N, Ryscavage P, Kulesza P. The utility of fine needle aspiration for diagnosis of extrapulmonary coccidioidomycosis: a case report and discussion. Clin Med Res. Nov 2011;9(3-4):130-3. [Medline].

  62. Ampel NM, Giblin A, Chavez S. Factors and outcomes associated with the decision to treat primary pulmonary coccidioidomycosis (abstract). San Diego, CA: Infectious Diseases Society of America 45th annual meeting; October 4-7, 2007.

  63. Mofenson LM, Brady MT, Danner SP, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. Sep 4 2009;58:1-166. [Medline]. [Full Text].

  64. Galgiani JN, Catanzaro A, Cloud GA, et al. Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Mycoses Study Group. Ann Intern Med. Nov 7 2000;133(9):676-86. [Medline].

  65. Anstead GM, Corcoran G, Lewis J, Berg D, Graybill JR. Refractory coccidioidomycosis treated with posaconazole. Clin Infect Dis. Jun 15 2005;40(12):1770-6. [Medline].

  66. Prabhu RM, Bonnell M, Currier BL, Orenstein R. Successful treatment of disseminated nonmeningeal coccidioidomycosis with voriconazole. Clin Infect Dis. Oct 1 2004;39(7):e74-7. [Medline].

  67. Catanzaro A, Cloud GA, Stevens DA, et al. Safety, tolerance, and efficacy of posaconazole therapy in patients with nonmeningeal disseminated or chronic pulmonary coccidioidomycosis. Clin Infect Dis. Sep 1 2007;45(5):562-8. [Medline].

  68. Ramani R, Chaturvedi V. Antifungal susceptibility profiles of Coccidioides immitis and Coccidioides posadasii from endemic and non-endemic areas. Mycopathologia. Jun 2007;163(6):315-9. [Medline].

  69. Park DW, Sohn JW, Cheong HJ, Kim WJ, Kim MJ, Kim JH, et al. Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole. BMC Infect Dis. Feb 15 2006;6:26. [Medline].

  70. Schein R, Homans J, Larsen RA, Neely M. Posaconazole for Chronic Refractory Coccidioidal Meningitis. Clin Infect Dis. Oct 10 2011;[Medline].

  71. Paugam A. [The latest data on posaconazole]. Med Mal Infect. Feb 2007;37(2):71-6. [Medline].

  72. Nagappan V, Deresinski S. Reviews of anti-infective agents: posaconazole: a broad-spectrum triazole antifungal agent. Clin Infect Dis. Dec 15 2007;45(12):1610-7. [Medline].

  73. Stevens DA, Rendon A, Gaona-Flores V, Catanzaro A, Anstead GM, Pedicone L, et al. Posaconazole therapy for chronic refractory coccidioidomycosis. Chest. Sep 2007;132(3):952-8. [Medline].

  74. Ampel N. Posaconazole for coccidioidomycosis. Journal Watch ID,. Aug 2007, CID Sep 2007.

  75. Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies. Medicine (Baltimore). May 2004;83(3):149-75. [Medline].

  76. Antony S. Use of the echinocandins (caspofungin) in the treatment of disseminated coccidioidomycosis in a renal transplant recipient. Clin Infect Dis. Sep 15 2004;39(6):879-80. [Medline].

  77. Hsue G, Napier JT, Prince RA, Chi J, Hospenthal DR. Treatment of meningeal coccidioidomycosis with caspofungin. J Antimicrob Chemother. Jul 2004;54(1):292-4. [Medline].

  78. Galgiani JN, Ampel NM, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Practice guideline for the treatment of coccidioidomycosis. Infectious Diseases Society of America. Clin Infect Dis. Apr 2000;30(4):658-61. [Medline].

  79. Vinh DC, Masannat F, Dzioba RB, Galgiani JN, Holland SM. Refractory disseminated coccidioidomycosis and mycobacteriosis in interferon-gamma receptor 1 deficiency. Clin Infect Dis. Sep 15 2009;49(6):e62-5. [Medline].

  80. Ampel NM, Giblin A, Mourani JP, Galgiani JN. Factors and outcomes associated with the decision to treat primary pulmonary coccidioidomycosis. Clin Infect Dis. Jan 15 2009;48(2):172-8. [Medline].

  81. Berry CD, Stevens DA, Hassid EI, Pappagianis D, Happs EL, Sahrakar K. A new method for the treatment of chronic fungal meningitis: continuous infusion into the cerebrospinal fluid for coccidioidal meningitis. Am J Med Sci. Jul 2009;338(1):79-82. [Medline].

  82. Caldwell JW, Arsura EL, Kilgore WB, Garcia AL, Reddy V, Johnson RH. Coccidioidomycosis in pregnancy during an epidemic in California. Obstet Gynecol. Feb 2000;95(2):236-9. [Medline].

  83. Arnold CA, Rakheja D, Arnold MA, et al. Unsuspected, disseminated coccidioidomycosis without maternofetal morbidity diagnosed by placental examination: case report and review of the literature. Clin Infect Dis. Jun 1 2008;46(11):e119-23. [Medline].

  84. Vikram HR, Blair JE. Coccidioidomycosis in transplant recipients: a primer for clinicians in nonendemic areas. Curr Opin Organ Transplant. Dec 2009;14(6):606-12. [Medline].

  85. Blair JE. Approach to the solid organ transplant patient with latent infection and disease caused by Coccidioides species. Curr Opin Infect Dis. Aug 2008;21(4):415-20. [Medline].

  86. Brugiere O, Forget E, Biondi G, Metivier AC, Mal H, Dauriat G. Coccidioidomycosis in a lung transplant recipient acquired from the donor graft in France. Transplantation. Dec 15 2009;88(11):1319-20. [Medline].

  87. Mortimer RB, Libke R, Eghbalieh B, Bilello JF. Immune reconstitution inflammatory syndrome presenting as superior vena cava syndrome secondary to Coccidioides lymphadenopathy in an HIV-infected patient. J Int Assoc Physicians AIDS Care (Chic Ill). Nov-Dec 2008;7(6):283-5. [Medline].

  88. Herr RA, Hung CY, Cole GT. Evaluation of two homologous proline-rich proteins of Coccidioides posadasii as candidate vaccines against coccidioidomycosis. Infect Immun. Dec 2007;75(12):5777-87. [Medline]. [Full Text].

  89. Capone D, Marchiori E, Wanke B, et al. Acute pulmonary coccidioidomycosis: CT findings from 15 patients. Br J Radiol. Sep 2008;81(969):721-4. [Medline].

  90. Galgiani JN. Vaccines to prevent systemic mycoses: holy grails meet translational realities. J Infect Dis. Apr 1 2008;197(7):938-40. [Medline].

  91. Hot A, Maunoury C, Poiree S, Lanternier F, Viard JP, Loulergue P. Diagnostic contribution of the positron emission scanning with 18F-FDG for invasive fungal infections. Clin Microbiol Infect. Jul 15 2010;[Medline].

  92. Pena-Ruiz MA, Meza AD, Mulla ZD. Coccidioidomycosis infection in a predominantly Hispanic population. Ann N Y Acad Sci. Sep 2007;1111:122-8. [Medline].

 
Previous
Next
 
Soft tissue abscess due to cocci.
Pulmonary cocci spherule (Hematoxylin-eosin stain).
Pulmonary cocci spherule, periodic acid-Schiff stain.
Erythema nodosum can be observed in coccidioidomycosis, tuberculosis, histoplasmosis, drug reactions, and streptococcal infections.
A Coccidioides immitis spherule containing daughter cysts. Courtesy of Thomas Matthew.
Arthroconidia become airborne and infect the human host to begin the parasitic phase of its life cycle. The arthroconidia develop into spherules containing endospores, which propagate infection in human tissues. Courtesy of Thomas Matthew.
A granuloma with coccidioides immitis spherule (pretracheal lymph node biopsy).
A ruptured Coccidioides immitis spherule (pretracheal lymph node biopsy).
Gomori methenamine silver stain of Coccidioides immitis spherule (pretracheal lymph node biopsy).
Periodic acid-Schiff stain of Coccidioides immitis spherule (pretracheal lymph node biopsy).
Coccidioidal spherules rupturing and releasing endospores. Gomori methenamine silver (GMS) stain. Photograph by Joseph Rabban, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.