What is including in long-term monitoring 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

Regular follow-up visits with a primary physician are necessary to document resolution or development of complications. Monitoring visits should be scheduled every 1-3 months and should include a patient interview, physical examination, serologic testing, radiographic examinations, and procedures, as necessary. Patients receiving antifungal therapy require continued monitoring for adverse effects of these agents by history and laboratory testing.

Expert consultations should be considered if needed. Continue follow-up care for at least 1-2 years or until resolution of all coccidioidal disease occurs.

Patients with complications such as chronic pulmonary and all extrapulmonary infections should receive routine follow-up for several years after diagnosis. Follow-up care of patients with disseminated coccidioidomycosis includes periodic monitoring of the complement fixation (CF) titer. Initially, monitor CF titers monthly until a consistent decrease has been documented; continue to measure titers periodically until the level is less than 1:8. Also monitor other abnormal laboratory or radiographic studies at regular intervals.

Relapses of coccidioidomycosis can be predicted by recurrence of symptoms, physical findings, and increases in the CF titer. Development of hydrocephalus in a patient with coccidioidal meningitis who is otherwise stable and improving does not imply failure of antifungal therapy.

Monitor routine health maintenance as well as reviews of all medications for potential drug interactions with the prescribed antifungal therapy.


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