What is included in inpatient treatment of 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

Sepsis syndrome, respiratory distress, severe hypoxemia, or severe or unresolving pneumonia as manifestations of acute or disseminated coccidioidal infection are indications for inpatient management. Coccidioidal disease that requires surgical intervention is best managed in an inpatient setting. Refractory cases requiring intravenous amphotericin also require hospitalization; however, once the patient is stable, he or she can be treated in an infusion center environment.

While patients with suspected coccidioidal meningitis can be treated adequately in an outpatient setting, hospitalization helps facilitate confirmation of diagnosis and initiation of therapy.

In a retrospective assessment 158 of 536 patients identified during the first 4 months of a coccidioidal epidemic required hospitalization. [33] The most important factors associated with hospitalization was shortness of breath, followed by age greater than 50 years; African descent; chills, fever, and cough; a negative skin test result; and an initial complement-fixation titer greater than 1:32. Patients who developed erythema nodosum were approximately one third as likely as the others to require hospitalization.

Isolation precautions are not necessary with hospitalized patients because person-to-person transmission of the disease does not occur; however, draining wounds may pose an infectious risk from aerosolization of organisms growing in the dressing or cast material. Enforce proper disposal of contaminated materials. [2]


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