ABSTRACT
Coccidioidal infection can manifest as pulmonary or extrapulmonary disease. Pulmonary
coccidioidomycosis occurs in 95% of all cases and can be divided into three main categories:
primary, complicated, and residual pulmonary coccidioidomycosis.
The primary infection occurs with inhalation of airborne arthroconidia. As few as
10 arthroconidia are capable of causing an infection in animal models. Sixty percent
of infected individuals will remain asymptomatic. This results in a positive skin
test and, with rare exception, lifelong immunity. The other 40% will develop symptomatic
disease that manifests with variable signs and symptoms, predominantly an influenza-like
syndrome, pneumonia, or pleural effusion.
The category of complicated pulmonary coccidioidomycosis includes clinical entities
as severe and persistent pneumonia, progressive primary coccidioidomycosis, fibrocavitary
coccidioidomycosis, cavities, and empyema, a complication of a ruptured cavity. Progression
of primary pulmonary disease to acute respiratory distress syndrome (ARDS) can also
qualify as a complication.
The third category of residual disease comprises only two entities: pulmonary nodule
and fibrosis. This review focuses on uncomplicated and complicated pulmonary coccidioidomycosis
and its management as outlined earlier in addition to special considerations of coccidioidal
fungemia, pulmonary coccidioidomycosis in pregnancy, and organ transplantation.
KEYWORDS
Pulmonary coccidioidomycosis - complicated pulmonary coccidioidomycosis - residual
pulmonary coccidioidomycosis - progressive primary coccidioidomycosis - fibrocavitary
coccidioidomycosis
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Irene M SpinelloM.D.
Critical Care and Pulmonary Services, Kern Medical Center
1830 Flower St., Bakersfield, CA 93305
Email: spinelloi@kernmedctr.com
