Coccidioidomycosis

Abstract

The significance of coccidioidomycosis is heightened by the rapid population growth in the American Southwest, increased travel to and through the area, and the rise of this deep fungal infection as an opportunistic infection in immunocompromised patients. Prevalence rates appear to be declining in some endemic areas, probably because of environmental factors, and a reduction in morbidity and mortality from disseminated disease has been noted. Approximately half of all symptomatic infections have cutaneous manifestations, and the skin is the organ most frequently involved in cutaneous coccidioidomycosis, with a challenging diversity of morphologic presentations. Spherulin has improved the sensitivity of skin testing, and serodiagnostic techniques have been refined. Ketoconazole has a definite role in the treatment of many cases of disseminated disease, and itraconazole appears very promising. With current treatment, prognosis in the nonimmunocompromised patient is excellent.