Management of Coccidioidomycosis

Diagnosis and Assessment

The Infectious Diseases Society of America recommends assessing for disseminated disease immediately in patients with positive IgG antibody tests, as this indicates recent or active coccidioidal infection 2
Extrapulmonary manifestations such as chronic skin ulceration, subcutaneous abscesses, focal skeletal pain, or persistent headache should be examined for in patients with coccidioidomycosis 2
Chest radiography should be obtained to evaluate pulmonary involvement in patients with coccidioidomycosis 1
Lumbar puncture with CSF analysis should be performed if the patient has unusual, worsening, or persistent headache, altered mental status, unexplained nausea/vomiting, or new focal neurologic deficits 1

The American College of Physicians recommends initiating fluconazole 400 mg daily orally (or 6-12 mg/kg/day for pediatric dosing) in symptomatic or high-risk patients with coccidioidomycosis 1, 4
Treatment duration should extend until clinical resolution and serologic improvement, with a minimum of 3-6 months 3, 5
For severe or rapidly progressive disease, intravenous amphotericin B should be started until clinical stabilization, then transitioned to fluconazole 1

Serial assessments are mandatory regardless of treatment decision, with clinical evaluation every 1-3 months for the first year 1, 3
Repeat serologic testing and chest radiography should be performed to assess pulmonary changes and document declining titers 1, 3
Monitoring should continue for at least 1-2 years to identify late complications including dissemination 1, 3