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Gregory M. Anstead

and John R. Graybill



Diagnosis—laboratory precautions and handling rules; new diagnostic tests.

Clinical presentation—community-acquired pneumonia.

Treatment—selection of antifungal agents.

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date: 27 September 2021

Coccidioidomycosis results from inhalation of arthroconidia of Coccidioides spp., which are soil fungi endemic to the south-western United States of America and parts of Latin America. Most infections are asymptomatic, but primary infection may resemble community-acquired pneumonia, sometimes with hypersensitivity manifestations such as erythema nodosum, erythema multiforme, and arthritis. Acute pulmonary infection usually resolves spontaneously, but—especially in immunocompromised patients, African Americans, and Filipinos—it may progress to persistent pulmonary disease or disseminate to skin, soft tissues, the osteoarticular system, and the central nervous system. Diagnosis is by culture, histopathology or serology. Fluconazole and itraconazole are usually the initial drugs of choice, with amphotericin B reserved for severe pulmonary and disseminated disease, and in pregnancy. In refractory cases, posaconazole and voriconazole are alternative antifungal agents....

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