Coccidioidomycosis as a Common Cause of Community-acquired Pneumonia

The early manifestations of coccidioidomycosis (valley fever) are similar to those of other causes of community-acquired pneumonia (CAP). Without specific etiologic testing, the true frequency of valley fever may be underestimated by public health statistics. Therefore, we conducted a prospective observational study of adults with recent onset of a lower respiratory tract syndrome. Valley fever was serologically confirmed in 16 (29%) of 55 persons (95% confidence interval 16%–44%). Antimicrobial medications were used in 81% of persons with valley fever. Symptomatic differences at the time of enrollment had insufficient predictive value for valley fever to guide clinicians without specific laboratory tests. Thus, valley fever is a common cause of CAP after exposure in a disease-endemic region. If CAP develops in persons who travel or reside in Coccidioides-endemic regions, diagnostic evaluation should routinely include laboratory evaluation for this organism

THE TREATMENT OF COCCIDIOIDOMYCOSIS

Therapy of coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. Individuals with suppressed cellular immunity are at increased risk for symptomatic coccidioidomycosis and they include those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant. Pregnant women and African-American men have been identified as two other groups who are at an increased risk for symptomatic and severe infection.A terapia da coccidioidomicose continua a evoluir. Para a doença pulmonar primária, o tratamento antifúngico frequentemente não é necessário, enquanto períodos prolongados de tratamento antifúngico são geralmente necessários para aqueles nos quais houve disseminação extratorácica. A anfotericina B intravenosa deve ser reservada para pacientes com doença grave. Antifúngicos triazólicos orais têm tido um grande impacto no manejo da coccidioidomicose. Tanto fluconazol quanto itraconazol em doses diárias de 400 mg foram eficazes contra várias formas de coccidioidomicose, incluindo a meníngea, embora recaídas após a interrupção da terapia ainda constituam um problema. Indivíduos com supressão da imunidade celular apresentam risco aumentado para a coccidioidomicose sintomática, incluindo pacientes infectados pelo HIV, em uso de medicações imunossupressoras, e os que receberam transplantes de órgãos sólidos. Mulheres grávidas e homens afro-americanos foram identificados como dois outros grupos que apresentam risco aumentado de infecção sintomática e grave

Coccidioidomycosis: Changing Concepts and Knowledge Gaps

Although first described more than 120 years ago, much remains unknown about coccidioidomycosis. In this review, new information that has led to changing concepts will be reviewed and remaining gaps in our knowledge will be discussed. In particular, new ideas regarding ecology and epidemiology, problems and promises of diagnosis, controversies over management, and the possibility of a vaccine will be covered

Challenges to Implementing a Vaccine for Coccidioidomycosis.

A vaccine for coccidioidomycosis is likely to undergo trials in the near future. In this paper, we raise 4 questions that should be answered before its use and offer our solutions to these questions. These include defining the goals of vaccination, determining who should be vaccinated, how to measure vaccine immunity and protection, and how to address vaccine hesitancy and denial