Coccidioidomycosis

Coccidioidomycosis is an endemic fungal infection caused by the dimorphic fungus Coccidioides spp. It is endemic in the southwestern US, southcentral Washington, northern Mexico, and some parts of Latin America, but much of its epidemiology remains unknown. Most infections are asymptomatic or mildly symptomatic, with pulmonary disease being the most common manifestation in those with clinical symptoms. Cellular immunity is vital in controlling the disease and preventing its dissemination. Patients on immunosuppressive medications and with depressed cellular immunity such as solid organ transplant and hematopoietic transplant recipients and people living with human immunodeficiency virus (HIV) with CD4 <250/μL are at the highest risk of dissemination. A high index of clinical suspicion and accurate travel history to endemic areas are critical in making a timely diagnosis and appropriate management. Antifungal therapy with azoles or polyenes needs to be individualized based on the severity of symptoms and the risk of dissemination. Preventive measures play an essential role in endemic areas in certain high-risk populations.