Coccidioides Immitis - Treatment

Treatment

  • Most Coccidioides infections resolve without specific therapy; few clinical trials have assessed outcomes in less-severe disease.
  • Commonly used indicators to judge the severity of illness:
  • Continuous fever for longer than 1 month
  • Body-weight loss of more than 10%
  • Intense night sweats that persist for more than 3 weeks
  • Infiltrates that involve more than half of one lung or portions of both lungs
  • Prominent or persistent hilar adenopathy
  • Anticoccidioidal complement fixation (CF) IgG titers of 1:16 or higher
  • Absence of dermal hypersensitivity to coccidioidal antigens
  • Inability to work
  • Symptoms that persist for more than 2 months
  • Risk factors for dissemination (for which treatment should be initiated):
  • Primary infection during infancy
  • Primary infection during pregnancy, especially in the third trimester or immediately postpartum
  • Immunosuppression (e.g., patients with HIV/AIDS, transplant recipients, patients receiving high-dose corticosteroids, those receiving anti–tumor necrosis factor medications)
  • Chronic debilitation or underlying disease, including diabetes mellitus or preexisting cardiopulmonary disease
  • High inoculum exposures
  • Certain ethnicities, such as Filipino, black, or Hispanic
  • Age greater than 55 years

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