Diagnosing and Treating Coccidioidomycosis
Coccidioidomycosis is diagnosed and treated differently from other causes of pneumonia. Early diagnosis and recognition of the disease are important to allow appropriate follow-up and treatment of affected individuals, as well as to avoid unnecessary treatment and tests.
What To Expect
Coccidioidomycosis often goes unrecognized and requires specific testing to make a diagnosis. Healthcare providers may not always consider coccidioidomycosis in people who are at risk for the disease. In particular, people who have traveled to the regions where cthe infection is most likely to occur ("endemic" regions) but develop disease after returning may be at risk for misdiagnosis, as healthcare providers outside of these areas may be less familiar with the disease. For these reasons, the diagnosis of coccidioidomycosis is often delayed and may require multiple visits to a healthcare provider.
How Coccidioidomycosis Is Diagnosed
Coccidioidomycosis is most commonly diagnosed by a blood test. This test examines the response of the immune system to the fungus. An abnormal blood test in the appropriate clinical setting is adequate to make the diagnosis. Early in the course of infection, with recent onset of symptoms, the initial test may be negative, and repeat testing is advised. A definitive diagnosis is made by demonstrating the presence of the fungus, either by examination of infected tissue with a microscope or by growth in a lab. Testing for coccidioidomycosis may include:
- Blood tests
- Sputum samples, produced by coughing or bronchoscopy
- Chest X-ray and/or CT scan
- Biopsy of the affected site, typically the lung
How Coccidioidomycosis Is Treated
Most individuals with coccidioidomycosis do not require specific treatment. Treatment with antifungal medications may be prescribed for those with more severe symptoms or symptoms lasting 8 weeks or longer.
Treatment may be considered earlier or in less severe disease in people with the following conditions or risk factors:
- Chronic obstructive pulmonary disease (COPD)
- Chronic kidney disease
- Congestive heart failure (CHF)
- Immunocompromised conditions
- African-American or Filipino-American ethnicity
Diagnosed individuals who require treatment are typically treated with an antifungal medication taken as a pill. Therapy typically lasts for several months, and the length will vary depending on response to treatment as determined by symptoms and diagnostic tests. More severe cases may require hospitalization and intravenous (IV) antifungal medication. In patients with depressed immune systems or with disease outside the lung (disseminated), lifelong therapy may be required. In very few individuals, surgery may be required to remove portions of infected or damaged lung.
This content was developed in partnership with the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.