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Management of pulmonary sequelae and complications of coccidioidomycosis

Author
Dawn Jaroszewski, MD, MBA, FACS
Section Editor
Carol A Kauffman, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Approximately two-thirds of people experience few or no symptoms following respiratory exposure to arthroconidia of Coccidioides spp. Those who become ill typically develop symptoms, such as cough, pleurisy, fever, and weight loss, one to three weeks after exposure; these symptoms generally resolve over the ensuing several months [1,2]. Marked fatigue, one of the common manifestations of the primary infection, may be especially prolonged and slow to resolve.

Whether or not the primary exposure is recognized, most infections are self-limited without additional events or complications. However, occasional patients have persistent pulmonary consequences of coccidioidomycosis that require medical and/or surgical management. These include residual pulmonary nodules, coccidioidal cavities, and diffuse reticulonodular pneumonia.

The clinical manifestations and management of these sequelae will be reviewed here. Primary and disseminated coccidioidomycosis are discussed separately. (See "Primary coccidioidal infection" and "Manifestations and treatment of extrapulmonary coccidioidomycosis" and "Coccidioidal meningitis".)

RESIDUAL PULMONARY NODULES

In approximately 4 percent of patients with primary coccidioidal pneumonia, infiltrates do not completely resolve and radiographic findings may persist for months to years following the disappearance of symptoms. These pulmonary nodules range up to several centimeters in diameter, are often solitary, and are frequently located in the periphery of the lung, close to or abutting the pleura.

Confirming the diagnosis — A residual nodule usually poses no problems and requires no treatment if it is known to be the consequence of an initial coccidioidal infection. However, in many cases, coccidioidal nodules are discovered incidentally and can be difficult to distinguish from malignancy.

        
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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2017.
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