Coccidioidomycosis: Difference between revisions
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==Background== | ==Background== | ||
*Fungal infection caused by Coccidioides immitis and C posadasii | *Fungal infection caused by ''Coccidioides immitis'' and ''C. posadasii'' | ||
*Organisms found in soil in arid climates of southwestern US and nearby areas | *Organisms found in soil in arid climates of southwestern US and nearby areas | ||
*Transmitted by inhalation of airborne spores | *Transmitted by inhalation of airborne spores | ||
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*[[Paracoccidioidomycosis]] | *[[Paracoccidioidomycosis]] | ||
*[[Pericarditis]] (acute or chronic) | *[[Pericarditis]] (acute or chronic) | ||
*[[Pneumocystis | *[[Pneumocystis jirovecii pneumonia]] | ||
*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
*Solitary pulmonary nodule | *Solitary pulmonary nodule | ||
*[[TB]] | *[[TB]] | ||
==Workup== | ==Evaluation== | ||
===Workup=== | |||
*Basic workup | *Basic workup | ||
**Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%) | **Typically normal WBC count or mild lymphocytosis, monocytosis, and/or [[eosinophilia]] (>5%) | ||
**Elevated ESR | **Elevated ESR | ||
**CXR | **[[CXR]] | ||
**[[LP]] if suspect [[meningitis]] | **[[LP]] if suspect [[meningitis]] | ||
*Special testing | *Special testing | ||
| Line 58: | Line 59: | ||
**Skin testing | **Skin testing | ||
== | ==Management== | ||
*Often self-limited mild disease not requiring treatment | *Often self-limited mild disease not requiring treatment | ||
*[[Azoles]] first line | *[[Azoles]] first line | ||
*Treatment options | *Treatment options | ||
**[[Itraconazole]] - | **[[Itraconazole]] - 200mg 2-3 times/day orally | ||
**[[Fluconazole]] - 400- | **[[Fluconazole]] - 400-800mg/day orally or IV | ||
**[[Ketoconazole]] - | **[[Ketoconazole]] - 400mg/day orally | ||
**[[Amphotericin B]] deoxycholate - 0.5-1. | **[[Amphotericin B]] deoxycholate - 0.5-1.5mg/kg/day IV | ||
**Lipid formulations of amphotericin B - 2- | **Lipid formulations of [[amphotericin B]] - 2-5mg/kg/day IV | ||
== | ==Disposition== | ||
* | |||
==See Also== | |||
*[[Fungal infections]] | |||
*[[Antifungals]] | |||
==References== | |||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 03:45, 8 March 2021
Background
- Fungal infection caused by Coccidioides immitis and C. posadasii
- 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
- 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