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Coccidioidomycosis - chronic pulmonaryDefinition Chronic pulmonary coccidioidomycosis is a lung infection caused by breathing in the fungus coccidioides. This fungus is found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America. Causes, incidence, and risk factors The infection is caused by breathing in the spores of a fungus found in desert regions such as Arizona or California's San Joaquin Valley. The disease can have an acute, chronic, or disseminated form. The chronic form usually develops after a period of months to years following a harmless infection that may have gone undiagnosed. Lung abscesses may form and may rupture into the pleural spaces causing empyema (pus in the pleural space) or bronchopleural fistula. Scarring (fibrosis) and cavities may gradually form in the upper lungs as the chronic form of coccidioidomycosis slowly progresses over months to years. Still, the majority of pulmonary coccidioidomycosis infections do not become chronic. In fact, the majority of infections cause no symptoms and are only recognized by a positive coccidioidin skin test. Dark-skinned people and people with a weak immune system are more susceptible to infection and more likely to form chronic or disseminated (spreading to other organs) forms of the disease. Symptoms
Additional symptoms that may be associated with this disease: Signs and tests
Treatment Antifungal medications are prescribed to treat the infection. The intravenous antibiotic, amphotericin B, is used for severe forms of disease. Itraconazole and fluconazole are oral antibiotic options with activity against this fungus. Ketoconazole is another option, but appears less effective. Treating any underlying immunocompromised state (such as AIDS) and minimizing immunosuppressant medications (such as steroids or chemotherapy) is also crucial if the patient's immune system is to properly fight the coccidioidomycosis fungal infection. Expectations (prognosis) With treatment the outcome is usually good, although relapses may occur. Some patients, such as those who are immunocompromised (from AIDS or immunosuppressing drugs) may need life-long anti-fungal medication to prevent relapse. Complications
Calling your health care provider Call for an appointment with your health care provider if coccidioidomycosis symptoms worsen or do not improve with treatment. Call your health care provider if new symptoms develop. Prevention Because coccidioidomycosis usually causes no symptoms -- or, in the majority of symptomatic infections, it usually resolves quickly on its own without causing significant symptoms -- there is generally no need to avoid infection. Immunocompromised people (such as AIDS patients and those on immunosuppressing drugs) may avoid travel to regions where this fungus is found, if they wish to minimize any risk of developing this rare, chronic disorder. References Chiller TM. Coccidioidomycosis. Infect Dis Clin North Am. 2003; 17(1): 41-57, viii. Illustrations
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