Infection with the fungus Coccidioides immitis may manifest in an acute or chronic illness and may, in some persons, be maintained in an asymptomatic state. This fungus is endemic in the southwestern United States. Those demonstrating symptoms usually complain of an influenza-like febrile respiratory illness. The disease may disseminate in approximately 0.5 percent.
Coccidioidomycosis should be considered in those with one or more of the following: (1) influenza-like signs and symptoms (fever, cough, chest pain, myalgia, arthralgia, and headache), (2) pneumonia or other pulmonary lesion on chest radiograph, (3) erythema nodosum or erythema multiforme rash, (4) involvement of bones, joints, or skin by dissemination, (5) meningitis, and (6) involvement of viscera or lymph nodes.
Laboratory confirmation is made through (1) culture, histopathology, or molecular evidence of C. immitis, (2) serologic tests including detection of IgM by immunodiffusion, enzyme immunoassay, latex agglutination, or tube precipitation or detection of rising titer of IgG by immunodiffusion, enzyme immunoassay, or complement fixation, or (3) coccidioidal skin-test conversion after onset of symptoms.
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