Coccidioides Immitis Infection

GENERAL PRINCIPLES

• Coccidioidomycosis often occurs in AIDS patients who live in endemic areas such as the southwestern United States, Central America, and South America.

• Infection may be limited to pneumonia or disseminated with possible involvement of CNS, skin, bones, and joints.

DIAGNOSIS

• Suspect coccidioidomycosis in patients with fever, cough, night sweats, joint pains, and travel to an endemic area.

• Diagnosis is made by a positive culture or biopsy demonstrating 20-70 #956;m spherules; serum serological tests can also aid in the diagnosis.

TREATMENT

• Disseminated disease is treated with liposomal amphotericin B, 4-6 mg/kg IV daily for 2 weeks or until the patient clinically improves, followed by fluconazole or itraconazole for at least 12 months.

• CNS disease is initially treated with fluconazole 800-1200 mg daily; liposomal amphotericin may be added to the initial regimen. Treatment with fluconazole is continued lifelong.