Which factors increase the risk for disseminated coccidioidomycosis?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
Answer

Dissemination usually occurs weeks to months after the initial infection but may occur after 1 year in a host who is immunocompromised. In addition, reactivation of treated primary disease may occur at any time in a host who is immunosuppressed. Some patients may have no radiographic evidence of previous pulmonary disease, as well as no history of a preceding respiratory illness.

Factors associated with increased risk of more severe coccidioidal disease include the following:

  • HIV disease, especially when CD4+ cell counts are < 250/mL [32]

  • Pregnancy; the risk increases slightly with each progressive trimester

  • Lymphoma

  • Immunosuppressive therapy in solid organ transplant recipients (especially during first year after transplantation)

  • Long-term corticosteroid treatment (>20 mg prednisone)

  • Treatment with tumor necrosis factor (TNF)-alpha inhibitors [36]

  • Chemotherapy for solid tumors

  • Diabetes mellitus

  • Preexisting cardiopulmonary conditions

  • Thymectomy

The male-to-female ratio in disseminated disease is 5:1, but this disparity reverses in pregnant women.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!