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Primary coccidioidal infection

John N Galgiani, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Coccidioidomycosis is the infection caused by the dimorphic fungi of the genus Coccidioides (C. immitis and C. posadasii) [1]. Most infections are caused by inhalation of spores. The clinical expression of disease ranges from self-limited acute pneumonia (Valley Fever) to disseminated disease, especially in immunosuppressed patients. The concentration of cases of coccidioidomycosis in the United States is in the southwestern part of the country, where the cumulative incidence of patients requiring hospitalization in 2002 was 28.65 per 1 million persons [2].

The clinical manifestations of uncomplicated primary infection, specific diagnostic tests, and management strategies for primary infection will be reviewed here. Complicated infections related to coccidioidomycosis are discussed elsewhere. (See "Management of pulmonary sequelae and complications of coccidioidomycosis" and "Coccidioidal meningitis" and "Manifestations and treatment of extrapulmonary coccidioidomycosis" and "Coccidioidomycosis in compromised hosts".)


Coccidioides spp are endemic to certain lower deserts of the western hemisphere, including southern Arizona, the southern and central valleys of California, southwestern New Mexico, and west Texas in the United States. They are also found in parts of Mexico and Central and South America. Although these are the most well-known regions, occasional small pockets of endemicity have been identified in more northern areas of the western United States. For example, repeated infections have occurred at a specific American Indian archeology site in Dinosaur National Monument in Utah [3]. Cases of coccidioidomycosis appear to have originated from eastern Washington state [4] and C. immitis has been detected in the soil in areas that two affected individuals visited [5]. Whole genome sequencing demonstrated genetic identity between an isolate from one of the patients and four soil isolates obtained from the area of exposure [6]. Increased reporting from all states might provide clues to other endemic pockets such as the one identified in Washington state [7,8].

A substantial increase in the incidence of coccidioidomycosis has been observed in endemic regions of the United States in recent years. In endemic states in which coccidioidomycosis is reportable to the United States Centers for Disease Control and Prevention (Arizona, California, Nevada, New Mexico, and Utah), the incidence of coccidioidomycosis increased from 5.3 cases per 100,000 population in 1998 to 42.6 cases per 100,000 population in 2011 [9]. Arizona and California account for 66 and 31 percent, respectively, of all nationally reported infections. Inmates of two California state prisons have been disproportionately affected by coccidioidomycosis compared with the general population, with 180 cases recognized in 2005 [10].

Several factors have been identified in Arizona, which account for much of the increase. These include a shift to more sensitive serologic test results to define cases, year-to-year variation in precipitation, and a continued growth of the population in endemic areas. [9,11].


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Literature review current through: Sep 2016. | This topic last updated: Dec 1, 2015.
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