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Primary coccidioidal infection

Carol A Kauffman, MD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Coccidioidomycosis is the infection caused by the dimorphic fungi of the genus Coccidioides (Coccidioides immitis and Coccidioides 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. Cases of coccidioidomycosis in the United States are concentrated in the southwestern part of the country.

The clinical manifestations, 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".)


Coccidioidomycosis is the infection caused by the dimorphic fungi of the genus Coccidioides (C. immitis and C. posadasii). All isolates within the genus Coccidioides were formerly designated C. immitis. However, based upon DNA sequence analysis, the two species have been identified as distinct [2,3].

Isolates from one species are geographically distributed predominantly in California, and have retained the name C. immitis. The other species is distributed in Arizona, Utah, Texas, and other endemic regions throughout the western hemisphere, and is now designated C. posadasii. However, the spectrums of diseases caused by the two species are indistinguishable, and clinical laboratories are not routinely able to determine species. For this reason, it is simplest to refer to all isolates as Coccidioides species.

Coccidioides spp grow as mold a few inches below the surface of the desert soil. With dry conditions, the mycelia become very fragile, are easily fractured by even slight air turbulence into single-cell spores (arthroconidia) approximately 3 to 5 microns in size, and can remain suspended for prolonged periods of time in the air.

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Literature review current through: Dec 2017. | This topic last updated: Jul 05, 2017.
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