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Coccidioidomycosis, image, image - Coggle Diagram

- - - - Symptoms occur approximately 7 to 21 days after an exposure, which may or may not be apparent.
      - Localized pneumonia
      - Diffuse pulmonary disease
      - Generalized systemic symptoms, including fever, drenching night sweats, weight loss
      - Rheumatologic complaints (eg, arthralgias)
      - Cutaneous manifestations, such as erythema nodosum
      - Extrathoracic coccidioidomycosis
        
        Nonmeningeal
        
        Skin or subcutaneous soft tissue
        
        Osteoarticular involvement
        
        Vertebral infection
        
        Meningitis
        
        The most common symptom of coccidioidal meningitis is persistent headache that is present in approximately 75% of patients. Cognitive decline may also be seen. Nuchal rigidity is infrequent.
- - - - Immunodiffusion tests are generally performed to support the diagnosis when an initial EIA is positive.
      - Some labs offer immunodiffusion tests for initial evaluation.
      - Immunocompetent patients with disseminated coccidioidal infection generally have complement-fixing antibody titers of ≥1:16.
        
        Testing for serum or urine antigen can also be useful in this situation.
        
        The diagnosis should be confirmed by identifying Coccidioides in one or more sites outside the chest.
        
        Imaging of clinically suspicious areas.
        
        The diagnosis of coccidioidal meningitis requires a CSF sample. In addition to lymphocytic pleocytosis and hypoglycorrhachia, the diagnosis is usually established by identifying anticoccidioidal antibodies in the CSF. Isolating Coccidioides from CSF is uncommon.