What is the decision-making process for treatment selection in coccidioidomycosis?

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

Three questions should be asked before a case of coccidioidomycosis is treated.

  1. Is intervention necessary?

  2. If antifungal therapy would be beneficial, which agents are appropriate?

  3. Is a surgical procedure necessary for debridement and reconstruction of destructive lesions?

In the decision-making process, significant weight is given to the severity of infection, risk factors for dissemination (eg, race and ethnicity, extremes of age, immunologic status), any severe comorbidity (eg, diabetes, pregnancy, significant preexisting vital organ dysfunction, negative skin test results), and a serum complement-fixation IgG titer of at least 1:32. [14, 6, 2, 3, 7, 4, 8, 9, 59, 66, 60, 40, 45]


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