Makindo Medical Notes

🦠 Coccidioidomycosis is an infection caused by inhaling soil-based spores of the dimorphic fungus Coccidioides immitis. Endemic in dry desert regions of the Americas, it is also called "Valley Fever" or "San Joaquin Valley Fever".

🌍 About

• Endemic to dry regions: central California, Arizona, parts of Texas, Mexico, Central & South America.
• Outbreaks often occur after dust storms or soil disruption.

🤒 Clinical Presentation

• Pulmonary disease (commonest): Fever, cough, chest pain, malaise, erythema nodosum ("desert bumps").
• Subacute meningitic syndrome: Headache, malaise, cranial nerve palsies, progressive over months.
• Disseminated disease: (rare, ~0.5%) can cause:
  • Granulomatous meningitis
  • Osteomyelitis, septic arthritis
  • Pericardial effusion
  • Sepsis / septic shock

⚠️ Risk Factors for Dissemination

• Advanced HIV/AIDS (CD4 <250)
• Prolonged corticosteroid use
• Haematologic malignancy
• Solid organ transplantation
• TNF-α antagonists (etanercept, infliximab)

🧪 Investigations

• CXR: Pulmonary infiltrates, cavitation.
• Sputum: Rule out TB (differential).
• HIV test: AIDS-defining illness.
• Serology: IgM & IgG titres for diagnosis and monitoring.
• Skin test: Coccidioidin (not widely used now).
• CSF (if meningitis suspected): ↑ Protein, ↓ Glucose, ↑ WCC with eosinophils, positive complement fixation tests.

💊 Management

• Mild pulmonary disease: Often self-limiting, may need no antifungal therapy.
• Moderate-severe / disseminated disease: Oral azoles (fluconazole, itraconazole, ketoconazole) for 3–6 months. Posaconazole is an alternative.
• Severe / CNS disease: IV Amphotericin B.
• ⚠️ Long-term suppressive therapy may be required for meningitis.

📚 Key Teaching Points

• Think of it in travellers or migrants from endemic regions with unexplained pneumonia-like illness.
• Distinguish from TB (similar chest findings, chronic cough, cavitation).
• Important opportunistic infection in immunocompromised patients (HIV, transplant).
• Pregnant women are at increased risk of dissemination and require treatment.