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Do all patients with primary pulmonary coccidioidomycosis need antifungal therapy?

Simran Gupta, MD, Nikita Ashcherkin, MD and Janis E. Blair, MD
Cleveland Clinic Journal of Medicine August 2022, 89 (8) 451-455; DOI: https://doi.org/10.3949/ccjm.89a.21125

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    (A) A 22-year-old male with a left lower lung infiltrate (circle). (B) Repeat imaging 8 months after initiation of treatment showed interval clearance of previously visualized opacity.

  • Figure 2
    Figure 2

    (A) A 1.5-cm lingular nodule with adjacent satellite nodularity (arrow) likely a noncalcified granuloma related to coccidioidomycosis. (B) Bilateral bronchovascular and perilymphatic nodules (arrows) seen in all lung fields, with subsequent bronchoalveolar lavage studies growing Coccidioides spp.

  • Figure 3
    Figure 3

    Algorithm for serologic testing in suspected coccidioides infection.

    a Suspected in the presence of typical symptoms and radiographic findings.

    b Definitive diagnosis requires positive biopsy, tissue culture, or body fluid culture.

    CF = complement fixation testing; ID = immunodiffusion testing; IgG = immunoglobulin G; IgM = immunoglobulin M

Tables

  • TABLE 1

    Situations in which to consider antifungal therapy

    • Risk factors for severe disease: diabetes mellitus, African or Filipino descent, age over 65, immune compromise

    • Worsening symptoms for 4 to 6 weeks

    • Persistent symptoms for 8 weeks

    • Extrapulmonary dissemination

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