Acute pulmonary coccidioidomycosis is a lung infection caused by breathing in spores of Coccidioides immitis or Coccidioides posadasii, fungi found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America.

Coccidioides infection begins in the lungs after a person breathes in the spores.

Those who may develop more serious infection include:

• People of African or Philippine descent
• Those with weakened immune systems due to AIDS, diabetes, or medications that suppress the immune system

Occasionally the infection may develop into a long-term (chronic) lung disease or can reactivate after a long latent period.

Traveling to an area where these fungi are found is a risk for coccidioidal infection. Areas in the U.S. include Arizona, California (especially the San Joaquin Valley), and western Texas.

About 60% of infections get better without ever causing symptoms. In the remaining 40% of infections, symptoms range from mild (cold-like or flu-like) to severe (pneumonia).

In less than 1% of infections, the fungus spreads from the lungs through the bloodstream to involve the skin, bones, joints, lymph nodes, and central nervous system or other organs.

If they occur, symptoms may include:

• Chest pain (varies from mild to severe)
• Chills
• Cough
• Fever
• Headache
• Joint stiffness
• Lymph node swelling
• Muscle aches
• Muscle stiffness
• Night sweats
• Rash, may be painful, red lumps, on lower legs (erythema nodosum)
• Sputum or phlegm
• Weight loss

See also:

• Coccidioidomycosis
• Skin lesion of coccidioidomycosis

• Biopsy of lymph node or lung (often done with bronchoscopy)
• Blood test for antibodies to the fungus
• Bronchoscopy with lavage
• Complete blood count (CBC)
• Sputum smear (KOH test or Papanicolaou stain)

The acute disease usually goes away without treatment. Your health care provider may recommend bedrest and treatment of flu-like symptoms until your fever disappears.

In severe forms of the disease (for example, disseminated coccidioidomycosis), you may need antifungal treatment with amphotericin B, fluconazole, or itraconazole. The best length of treatment with these medications has not been determined.

The outlook in milder cases is usually good. Disseminated coccidioidomycosis can be serious, particularly in people with weakened immune systems from:

• Anti-tumor necrosis factor (TNF) therapy
• Chemotherapy
• Glucocorticoid medications (prednisone)
• Heart-lung (cardiopulmonary) conditions
• HIV
• Lymphoma
• Medications used to suppress the immune system in transplant patients
• Pregnancy (especially the first trimester)
• Type 1 or type 2 diabetes

• Chronic pulmonary coccidioidomycosis
• Disseminated coccidioidomycosis

Call your health care provider if:

• You have symptoms of coccidioidomycosis
• Your symptoms get worse or do not improve with treatment
• You develop new symptoms

Avoiding travel to regions where this fungus is found will prevent this disorder. However, this is not practical or possible for many people. It may be a good idea to avoid contact with soil in these regions if you have a weakened immune system due to HIV or other conditions.

Davies SF, Knox KS, Serosi GA. Fungal infections. In: Mason RJ, Murray J, Broaddus VC, Nadel J, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2005; chap 34.

Galgiani JN. Coccidioides species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 264.