• Fungal infection caused by Coccidioides immitis and C posadasii
  • Organisms found in soil in arid climates of southwestern US and nearby areas
  • Transmitted by inhalation of airborne spores
  • Also known as Valley Fever

Clinical Features

  • Often asymptomatic
  • Most commonly affects lungs
  • Mild ILI 1-4 weeks after exposure
  • More severe presentation
  • Rarely, respiratory failure
  • Disseminated disease, more common in immunosuppressed
    • Dramatic sweats
    • Dyspnea at rest
    • Fever
    • Weight loss
    • 50% develop meningitis

Differential Diagnosis



  • Basic workup
    • Typically normal WBC count or mild lymphocytosis, monocytosis, and/or eosinophilia (>5%)
    • Elevated ESR
    • CXR
    • LP if suspect meningitis
  • Special testing
    • Immunoglobulin testing
    • Culture
    • PCR testing
    • Skin testing


  • Often self-limited mild disease not requiring treatment
  • Azoles first line
  • Treatment options


    See Also


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