Coccidioidomycosis

Last Updated: 2020-08-11

Author(s): Anzengruber F., Navarini A.

ICD11: 1F25.Z

  • Wernicke 1892
  • Posadas 1892

Coccidioid granuloma, desert rheumatism, valley fever, California disease, coccidioidomycosis, San Joaquin valley fever, desert fever.

Systemic fungal infection, mainly occurring in America.

  • Southern USA, Central and South America
  • Up to 15 times more common in Asians and black people.

  • Pathogen: Coccidioides immitis, a dimorphic fungus 
  • Incubation period: 10-18 days
  • The transmission takes place via dust. Primary infection can lead to the occurrence of erythema nodosum or erythema exsudativum multiforme
  • In < 1% of cases haematogenic scattering leads to further organ infestation (skin, bone and CNS)
  • Association with immunosuppression

  • The pathogens are inhaled via lungs, where inoculation occurs. The infection rarely occurs via skin. 
  • Flu-like symptoms (febrile temperatures, thoracic pain, cough, dyspnea, haemoptoe). 
  • Cutaneously, one can see verruciform, scar-healing granulomas, especially in the area of the nasolabial folds and on the capillitium. Abscess and fistula formation may occur

  • Pathogen detection (pus, sputum, bronchoalveolar lavage, blood, urine or cerebrospinal fluid) 
  • Biopsy 
  • Serologically specific antibody detection 
  • Intradermal skin test

Meningitis.

  • The disseminated form can lead to a lethal course, if untreated.  
  • Frequent relapses. 

  1. Bialek R, Gonzalez GM, Begerow D, Zelck UE. Coccidioidomycosis and blastomycosis: Advances in molecular diagnosis. FEMS Immunology & Medical Microbiology 2005;45:355-60.
  2. Braverman IM. Protective effects of erythema nodosum in coccidioidomycosis. The Lancet 1999;353:168.
  3. Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis. Medicine 2004;83:149-75.
  4. Einstein HE, Johnson RH. Coccidioidomycosis: New Aspects of Epidemiology and Therapy. Clinical Infectious Diseases 1993;16:349-56.
  5. Horsburgh CR, Jr., Cannady PB, Jr., Kirkpatrick CH. Treatment of fungal infections in the bones and joints with ketoconazole. J Infect Dis 1983;147:1064-9.
  6. Kim A, Parker SS. Coccidioidomycosis: Case report and update on diagnosis and management. Journal of the American Academy of Dermatology 2002;46:743-7.
  7. Mathew G, Smedema M, Wheat LJ, Goldman M. Relapse of coccidioidomycosis despite immune reconstitution after fluconazole secondary prophylaxis in a patient with AIDS. Fallbericht. Coccidioidomykose-Ruckfall trotz Immunrekonstitution nach Fluconazol-Sekundarprophylaxe bei einem AIDS-Patienten. Mycoses 2003;46:42-4.
  8. Pappagianis D. Epidemiology of Coccidioidomycosis.  Coccidioidomycosis: Springer Science + Business Media; 1980:63-85.
  9. Polesky A, Kirsch Carl M, Synder Linda S, et al. Airway Coccidioidomycosis–Report of Cases and Review. Clinical Infectious Diseases 1999;28:1273-80.
  10. Ramos-e-Silva M, Saraiva LdES. Paracoccidioidomycosis. Dermatologic Clinics 2008;26:257-69.
  11. Shikanai Yasuda MA. Pharmacological management of paracoccidioidomycosis. Expert Opinion on Pharmacotherapy 2005;6:385-97.
  12. Tsukadaira A, Okubo Y, Sato E, Kubo K. Chronic coccidioidomycosis. The Lancet 2002;360:977.