• Royce H. JohnsonEmail author
  • Arash Heidari
Part of the Infectious Disease book series (ID)


Coccidioidomycos (CM) is a fungal infection caused by the endemic thermal dysmorphic fungal genus Coccidioides. The illness is usually acquired in the southwestern USA and adjacent areas of Mexico. Primary infection is virtually always pneumonic disease. Disseminated disease may occur in individuals with antecedent pulmonary disease or as a presenting manifestation. Dissemination can occur to any site, but disease of skin, bone, joint, and meninges is most common.

Therapy is complex, often protracted and less than ideal. The primary agents are azoles and amphotericin compounds. Relapses are common.


Coccidioidomycosis Coccidioides Fungal infections Fungal pneumonia Fungal osteomyelitis Fungal meningitis Fungal synovitis Fungal skin lesions 



The authors wish to thank D. Caldwell, J. Pusavat, and the recently deceased H. Einstein for their help and/or advice in the preparation of this chapter.


  1. 1.
    Posado A. Un nuevo caso de micosis fungoidea con psorospermias. Annales del Circulo Medico Argentina. 1892;5:585–97.Google Scholar
  2. 2.
    Wernicke R. Ueber einen Protozoenbefund bei Mycosis fungoides. Zentralb Bakt. 1892;12:859–61.Google Scholar
  3. 3.
    Rixford E, Gilchrist TC. Two cases of protozoan (coccidioidal) infection of the skin and other organs. John Hopkins Hosp Rep. 1896;1:209–68.Google Scholar
  4. 4.
    Ophuls W, Moffitt HC. A new pathogenic mould (formerly described as a protozoan: Coccodioides immitis): preliminary report. Phila Med J. 1900;5:1471–2.Google Scholar
  5. 5.
    Montenegro J. Septicemia por Coccidioides immitis. Brasil-med. 1925;1:69–70.Google Scholar
  6. 6.
    Beck MD. Occurrence of Coccidioides immitis in lesions of slaughtered animals. Proc Soc Exper Biol Med. 1929;26:534–6.CrossRefGoogle Scholar
  7. 7.
    Rand CW. Coccidioidal granuloma; report of two cases simulating tumor of the spinal cord. Arch Neurol Psychiat. 1930;23:502–11.CrossRefGoogle Scholar
  8. 8.
    Abbott KH, Cutler OI. Chronic coccidioidal meningitis: review of the literature and report of seven cases. Arch Path. 1936;21:320–30.Google Scholar
  9. 9.
    Pulford DS, Larson EE. Coccidioidal granuloma; report of a case treated by intravenous dye, colloidal lead, and colloidal copper, with autopsy observations. JAMA. 1929;93:1049–56 (Discussed by William Ophuls).CrossRefGoogle Scholar
  10. 10.
    Stewart RA, Meyer KF. Isolation of Coccidioides immitis (Stiles) from the soil. Proc Soc Exper Biol Med. 1932;29:937–8.CrossRefGoogle Scholar
  11. 11.
    Gifford MA. San Joaquin fever. Kern County Dept Public Health Annu Rep 1936;22–3.Google Scholar
  12. 12.
    Fiese MJ. Coccidioidomycosis. Springfield: Charles E Thomas; 1958.Google Scholar
  13. 13.
    Fisher MC, Koeneg GL, White TJ, et al. Molecular and phenotypic description of Coccidioides posadasii sp nov., previously describes as the non-California population of Coccidioides immitis. Mycologia. 2002;94:73–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention. Coccidioidomycosis in workers at an archeologic site–Dinosaur National Monument, Utah, June-July 2001. MMWR Morb Mortal Wkly Rep. 2001;50:1005–8.Google Scholar
  15. 15.
    Abuodeh RO, Orbach MJ, Mandel MA, et al. Genetic transformation of Coccidioides immitis facilitated by Agrobacterium tumefaciens. J Infect Dis. 2000;181:2106–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith CE. Diagnosis of pulmonary coccidioidal infections. California Med. 1951;75:385–91.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Marsden-Haug N, Goldoft M, et al. Coccidioidomycosis acquired in Washington State. Clin Infect Dis. 2013;56:847–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Dodge RR, Lebowitz MD, Barbee RA, et al. Estimates of C. immitis infection by skin test reactivity in an endemic community. Am J Public Health. 1985;75:863–5.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Larwood TR. Coccidioidin skin testing in Kern County, California: decrease in infection rate over 58 years. Clin Infect Dis. 2000;30:612–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Stevens DA. Current concepts: coccidioidomycosis. N Engl J Med. 1995;332:1077–82.CrossRefPubMedGoogle Scholar
  21. 21.
    Frieden TR, Jaffe HW. Increase in reported coccidioidomycosis—United States, 1998–2011. Morb Mortal Wkly Rep. 2013;62(12):217–21.Google Scholar
  22. 22.
    Centers for Disease Control and Prevention. Coccidioidomycosis-United States,1991–1992. MMWR Morb Mortal Wkly Rep. 1993;42:21–4.Google Scholar
  23. 23.
    Leake JA, Mosley DG, England B, et al. Risk factors for acute symptomatic. Coccidioidomycosis among elderly persons in Arizona,1996–1997. J Infect Dis. 2000;181:1435–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Komatsu K, Vaz V, Mcrill C, et al. Increase in coccidioidomycosis-Arizona, 1998–2001. JAMA. 2003;289:1500–2 (Reprinted from MMWR Morb Mortal Weekly Rep 2003;52:109).CrossRefGoogle Scholar
  25. 25.
    Park BJ, Sigel K, Vaz V, et al. An epidemic of coccidioidomycosis in Arizona associated with climate changes, 1998–2001. J Infect Dis. 2005;191:1981–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Brown J, Benedict K. Coccidioidomycosis: epidemiology. Clin Epidemiol. 2013;5:185–97.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Huang JY, Bristow B. Coccidioidomycosis-associated deaths, United States, 1990–2008. Emerg Infect Dis. 2012;18(11):1723–8.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Beaman L, Pappagianis D, Benjamini E. Mechanisms of resistance to infection with Coccidioides immitis in mice. Infect Immun. 1979;23:681–5.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis. 2001;33:1536–44.CrossRefPubMedGoogle Scholar
  30. 30.
    Woods CW, McRill C, Plikaytis BD, et al. Coccidioidomycosis in human immunodeficiency virus-infected persons in virus-infected persons in Arizona, 1994–1997: incidence, risk factors, and prevention. J Infect Dis. 2000;181:1428–34.CrossRefPubMedGoogle Scholar
  31. 31.
    Ampel NM, Bejarano GC, Galgiani JN. Killing of Coccidioides immitis by human peripheral blood mononuclear cells. Infect Immun. 1992;60:4200–4.PubMedCentralPubMedGoogle Scholar
  32. 32.
    De Moraes-Vasconcelos D, Grumach AS, Yamaguti A, et al. Paracoccidioides brasiliensis disseminated disease in a patient with inherited deficiency in the beta 1 subunit of the interleukin (IL)-12/IL-23 receptor. Clin Infect Dis. 2005;41:e31–e37.CrossRefPubMedGoogle Scholar
  33. 33.
    Zerbe CS, Holland SM. Disseminated histoplasmosis in persons with interferon gamma receptor 1 deficiency. Clin Infect Dis. 2005;41:e38–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Vinh DC, Masannat F. Refractory disseminated coccidioidomycosis and mycobacteriosis in interferon-gamma receptor 1 deficiency. Clin Infect Dis. 2009;49(6):e62–5.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Vinh DC, Schwartz B. Interleukin 12 receptor beta 1 deficiency predisposing to disseminated coccidioidomycosis. Clin Infect Dis. 2011;52(4):e99–102.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Forseth J, Rohwedder JJ, Levine BE, et al. Experience with needle biopsy for coccidioidal lung nodules. Arch Intern Med. 1986;146:319–20.CrossRefPubMedGoogle Scholar
  37. 37.
    Johnson RH, Caldwell JW, Welch G, et al. The great coccidioidomycosis epidemic: clinical features. In: Einstein HE, Catanzaro A, editors. Coccidioidomycosis. Proceedings of the fifth international conference. Washington, DC: National Foundation for Infectious Diseases; 1996. p. 77–87.Google Scholar
  38. 38.
    Quimby SR, Connolly SM, Winkelmann RK, et al. Clinicopathologic spectrum of specific cutaneous lesions of disseminated coccidioidomycosis. J Am Acad Dermatol. 1992;26:79–85.CrossRefPubMedGoogle Scholar
  39. 39.
    Elbaum DJ. Erythema sweetobullosum: the missing link in San Joaquin Valley fever. Proceedings of the 42nd Annual Coccidioidomycosis Study Group Meeting, Visalia, CA, April 4, 1998.Google Scholar
  40. 40.
    Sarosi GA, Parker JD, Doto IL, et al. Chronic pulmonary coccidioidomycosis. N Engl J Med. 1970;283:325–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Pappagianis D. Epidemiology of coccidioidomycosis. Curr Top Med Mycol. 1988;2:199–238.CrossRefPubMedGoogle Scholar
  42. 42.
    Louie L, Ng S, Hajjeh R, et al. Influence of host genetics on the severity of coccidioidomycosis. Emerg Infect Dis. 1999;5:672–80.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Woods CW, McRill C, Plikaytis BD, et al. Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994–1997: incidence, risk factors, and prevention. J Infect Dis. 2000;181:1428–34.CrossRefPubMedGoogle Scholar
  44. 44.
    Ampel NM. Coccidioidomycosis among persons with human immunodeficiency virus infection in the era of highly active antiretroviral therapy (HAART). Semin Respir Infect. 2001;16:257–62.CrossRefPubMedGoogle Scholar
  45. 45.
    Deresinski SC, Stevens DA. Coccidioidomycosis in compromised hosts: experience at Stanford University Hospital. Medicine (Baltimore). 1974;54:377–95.CrossRefGoogle Scholar
  46. 46.
    Rutala PJ, Smith JW. Coccidioidomycosis in potentially compromised hosts: the effect of immunosuppressive therapy in dissemination. Am J Med Sci. 1978;275:283–95.CrossRefPubMedGoogle Scholar
  47. 47.
    Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis. 2001;33:1536–44.CrossRefPubMedGoogle Scholar
  48. 48.
    Logan JL, Blair JE, Galgiani JN. Coccidioidomycosis complicating solid organ transplantation. Semin Respir Infect. 2001;16:251–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Walker MP, Brody CZ, Resnik R. Reactivation of coccidioidomycosis in pregnancy. Obstet Gynecol. 1992;79:815–17.PubMedGoogle Scholar
  50. 50.
    Peterson CM, Schuppert K, Kelly PC, et al. Coccidioidomycosis and pregnancy. Obstet Gynecol Surg. 1993;48:149–56.CrossRefGoogle Scholar
  51. 51.
    Bisla RS, Taber TH. Coccidioidomycosis of bone and joints. Clin Orthop. 1976;121:196–204.PubMedGoogle Scholar
  52. 52.
    Bried JH, Galgiani JN. Coccidioides immitis infections in bones and joints. Clin Orthop. 1986;211:235–43.PubMedGoogle Scholar
  53. 53.
    Lund PJ, Chan KM, Unger EC, et al. Magnetic resonance imaging in coccidioidal arthritis. Skeletal Radiol. 1996;25:661–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Rosen E, Belber JP. Coccidioidal meningitis of long duration: report of a case of four years and eight months duration, with necropsy findings. Ann Intern Med. 1951;34:796–808.CrossRefPubMedGoogle Scholar
  55. 55.
    Vincent T, Galgiani JN, Huppert M, et al. The natural history of coccidioidal meningitis: VA-Armed Forces Cooperative Studies, 1955–1958. Clin Infect Dis. 1993;16:247–54.CrossRefPubMedGoogle Scholar
  56. 56.
    Ragland AS, Arsura E, Ismail Y, Johnson RH. Eosinophilic pleocytosis in coccidioidal meningitis: frequency and significance. Am J Med. 1993;95:254–57.CrossRefPubMedGoogle Scholar
  57. 57.
    Biosafety in Microbiological and Biomedical Laboratories. CDC. Fourth Edition, May 1999.Google Scholar
  58. 58.
    Kaufman L, Sekhon AS, Moledina N, et al. Comparative evaluation of commercial Premier EIA and microimmunodiffusion and complement fixation tests for Coccidioides immitis antibodies. J Clin Microbiol. 1995;33:618–9.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Wieden MA, Lundergan LL, Blum J, et al. Detection of coccidioidal antibodies by 33-kDa spherule antigen, Coccidioides EIA, and standard serologic tests in sera from patients evaluated for coccidioidomycosis. J Infect Dis. 1996;173:1273–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Smith CE, Saito MT, Beard RR, et al. Serological tests in the diagnosis and prognosis of coccidioidomycosis. Am J Hyg. 1950;52:1–21.PubMedGoogle Scholar
  61. 61.
    Drutz DJ, Catanzaro A. Coccidioidomycosis: Part 1. Am Rev Respir Dis. 1978;117:559–85.PubMedGoogle Scholar
  62. 62.
    Penrose J, Johnson R, Einstein H, et al. Neuroimaging in coccidioidal meningitis. Proceedings of the 39th Annual Coccidioidomycosis Study Group Meeting, Bakersfield, CA, April 1, 1995.Google Scholar
  63. 63.
    Galgiani JN, Ampel NM, Blair JE, et al. Coccidioidomycoses. Clin Infect Dis. 2005;41:1217–23.CrossRefPubMedGoogle Scholar
  64. 64.
    Vaughn JE, Ramirez H. Coccidioidomycosis as a complication of pregnancy. Calif Med J. 1951;74:121–5.Google Scholar
  65. 65.
    Caldwell JW, Arsura EL, Kilgore WB, et al. Coccidioidomycosis in pregnancy during an epidemic in California. Obstet Gynecol. 2000;95:236–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Galgiani JN, Catanzaro A, Cloud GA, et al. Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis: a randomized, double-blind trial. Mycoses Study Group. Ann Intern Med. 2000;133:676–86.CrossRefPubMedGoogle Scholar
  67. 67.
    Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med. 1990;340:764–71.CrossRefGoogle Scholar
  68. 68.
    Shibli M, Ghassibi J, Hajal R, et al. Adjunctive corticosteroids therapy in acute respiratory distress syndrome owing to disseminated coccidioidomycosis. Crit Care Med. 2002;30:1896–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Bercovitch RS, Catanzaro A, et al. Coccidioidomycosis during pregnancy: a review and recommendations for management. Clin Infect Dis. 2011;53:363–8CrossRefPubMedGoogle Scholar
  70. 70.
    Classen DC, Burke JP, Smith CB. Treatment of coccidioidal meningitis with Fluconazole. J Infect Dis. 1988;158:903–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Galgiani JN, Catanzaro A, Cloud GA, et al. Fluconazole therapy for coccidioidal meningitis. Ann Intern Med. 1993;119:28–35.CrossRefPubMedGoogle Scholar
  72. 72.
    Proia LA, Tenorio AR. Successful use of voriconazole for treatment of Coccidioides meningitis. Antimicrobial Agents Chemother. 2004;48:2341.CrossRefGoogle Scholar
  73. 73.
    Cortez KJ, Walsh TJ, Bennett JE. Successful treatment of coccidioidal meningitis with voriconazole. Clin Infect Dis. 2003;36:1619–22.CrossRefPubMedGoogle Scholar
  74. 74.
    Schein R, Homans J, Larsen RA. Posaconazole for chronic refractory coccidioidal meningitis. Clin Infect Dis. 2011;53(12)1252–4CrossRefPubMedGoogle Scholar
  75. 75.
    Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006;42:103–7.CrossRefPubMedGoogle Scholar
  76. 76.
    Pappagianis D. Valley fever vaccine study group: evaluation of the protective efficacy of the killed Coccidioides immitis spherule vaccine in humans. Am Rev Respir Dis. 1993;148:656–60.CrossRefPubMedGoogle Scholar

Suggested Reading

  1. Galgiani JN. Coccidioides species. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 3040–51.Google Scholar
  2. Galgiani JN, Ampel NM, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41:1217–23.CrossRefPubMedGoogle Scholar
  3. Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006;43:103–7.CrossRefGoogle Scholar
  4. Stevens DA. Current concepts: coccidioidomycosis. N Engl J Med. 1995;332:1077–82.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of MedicineDavid Geffen School of Medicine at University of California Los AngelesLos AngelesUSA
  2. 2.Department of MedicineKern Medical CenterBakersfieldUSA
  3. 3.Internal Medicine, Division of Infectious DiseasesKern Medical CenterBakersfieldUSA

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