Coccidioidomycosis: The Daily PANCE Blueprint
A 42-year-old male presents with two weeks of cough, fatigue, and arthralgia. He recently returned from a camping trip in southern Arizona. Which of the following is the most important risk factor for developing coccidioidomycosis?
A. Recent travel to an endemic area
B. Exposure to sick contact
C. Consumption of contaminated water
D. History of water
E. Use of inhaled corticosteroids
Answer and topic summary
The answer is A. Recent travel to an endemic area
Coccidioidomycosis (aka “valley fever”) is a systemic fungal infection caused by Coccidioides immitis or Coccidioides posadasii. It is endemic to the southwestern United States and parts of Central and South America. It is caused by breathing in dust that contains the spores of the fungus Coccidioides found in the soil. The types of infection it can cause vary, but the most common presentation is coccidioidal pneumonia; patients typically present with cough, chest pain, fever, and dyspnea. There is also extra-thoracic coccidioidomycosis (more rare), which can manifest as meningitis, skin or soft tissue lesions, or even vertebral infections. Diagnosis is made with laboratory confirmation by serologic testing (EIA is the recommended initial test due to rapid turnaround and sensitivity). Most cases in general are mild and self-limited. However, anti-fungals are recommended for moderate to severe, persistent cases, disseminated disease, and for patients at increased risk of complications. Treatment options include fluconazole (preferred) or itraconazole. Those with very severe disease should be on amphotericin B and a triazole antifungal. With severe disease, treatment is typically 12-24 weeks.
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