chronic pulmonary coccidioidomycosis
chronic pulmonary coccidioidomycosisLung infection due to Coccidioides immitis and C posadasii, which are endemic in southwestern US. It affects up to 8% of those exposed to C immitis spores, often after a latency period of up to 20 years.
Two-thirds of patients are asymptomatic; others exposed develop a mild influenza-like illness 1–4 weeks after exposure, with fever, sore throat, cough, headache, fatigue and pleuritic chest pain. Increased risk of severe disease (e.g., HIV disease), especially with low CD4+ cell counts, pregnancy, lymphoma, organ transplants, prolonged corticosteroid treatment, tumour necrosis factor (TNF)-alpha inhibitor therapy.
Amphotericin B, azoles (e.g., ketoconazole, fluconazole); for those who fail to respond, the options are largely limited to experimental agents.