Coccidioidomycosis
[Lancet Infect Dis 2021;21:e364-74, Clin Infect Dis 2016;63:e112-46]
Usual Pathogens
Coccidioides immitis (primarily in California and Washington in USA and Northwest Mexico)
Coccidioides posadasii (southwestern regions of USA, Mexico and arid regions of South America)
- Causes meningitis (subacute or chronic), pulmonary and extra pulmonary infections (skin, bone, joint, lymph node).
- Infectious Diseases consult recommended.
Meningitis
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole | 400-1200mg PO daily | Lifelong |
| Alternative | ||
| Itraconazole | 400-800mg PO divided bid-qid |
Lifelong |
| Pregnancy [Clin Infect Dis 2011;53:1060] | ||
|
1st trimester: |
||
| Amphotericin B | 0.1-1.5mg intrathecal daily to weekly |
1st trimester |
| then | ||
| 2nd & 3rd trimester: | ||
| Fluconazole | 400-1200mg PO daily |
Lifelong |
Pulmonary
Mild with non-debilitating symptoms and asymptomatic immunocompetent patients with chronic nodular and/or cavitary disease - close observation; no antifungal therapy.
Mild with risk factors for persistence/progression or asymptomatic immunocompromised patient with chronic nodular and/or cavitary disease or symptomatic or progressive nodular and/or cavitary disease
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole | 400mg PO daily | 3-12 months |
| or | ||
| Itraconazole oral solution | 200mg PO bid |
3-12 months |
Severe/diffuse pneumonia
| Empiric Therapy | Duration | |
|---|---|---|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | Dependent on clinical response and quantitative serological tests every 12 weeks |
| or | ||
| Fluconazole | 800-1200mg PO daily |
Dependent on clinical response and quantitative serological tests every 12 weeks |
Disseminated/extrapulmonary (skin, bone, joint, lymph nodes)
Mild-moderate
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole | 400-1000mg PO daily | Dependent on clinical response and quantitative serological tests every 12 weeks |
| or | ||
| Itraconazole oral solution | 200-400mg PO bid |
Dependent on clinical response and quantitative serological tests every 12 weeks |
Severe or vertebral
| Empiric Therapy | Duration | |
|---|---|---|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | Dependent on clinical response and quantitative serological tests every 12 weeks |