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Updated: Jul 6, 2026
Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases
Published on: March 1, 2024
Pulmonary coccidioidomycosis
Irene M Spinello1, Augustine Munoz, Royce H Johnson
1Department of Medicine, Kern Medical Center, Bakersfield, California 93305, USA. spinelloi@kernmedctr.com
Abstract:
Coccidioidal infection can manifest as pulmonary or extrapulmonary disease. Pulmonary coccidioidomycosis occurs in 95% of all cases and can be divided into three main categories: primary, complicated, and residual pulmonary coccidioidomycosis. The primary infection occurs with inhalation of airborne arthroconidia. As few as 10 arthroconidia are capable of causing an infection in animal models. Sixty percent of infected individuals will remain asymptomatic. This results in a positive skin test and, with rare exception, lifelong immunity. The other 40% will develop symptomatic disease that manifests with variable signs and symptoms, predominantly an influenza-like syndrome, pneumonia, or pleural effusion. The category of complicated pulmonary coccidioidomycosis includes clinical entities as severe and persistent pneumonia, progressive primary coccidioidomycosis, fibrocavitary coccidioidomycosis, cavities, and empyema, a complication of a ruptured cavity. Progression of primary pulmonary disease to acute respiratory distress syndrome (ARDS) can also qualify as a complication. The third category of residual disease comprises only two entities: pulmonary nodule and fibrosis. This review focuses on uncomplicated and complicated pulmonary coccidioidomycosis and its management as outlined earlier in addition to special considerations of coccidioidal fungemia, pulmonary coccidioidomycosis in pregnancy, and organ transplantation.
Insights
Coccidioidal infection primarily affects the lungs, with most cases being asymptomatic. Symptomatic infections can range from mild flu-like illness to severe pneumonia, requiring specific management strategies.
Area of Science:
- Medical Mycology
- Pulmonology
- Infectious Diseases
Background:
- Coccidioidal infection, caused by inhaling airborne arthroconidia, commonly presents as pulmonary disease.
- Pulmonary coccidioidomycosis is categorized into primary, complicated, and residual forms.
- While 60% of infections are asymptomatic, 40% develop symptomatic disease with diverse presentations.
Purpose of the Study:
- To review the classification and management of pulmonary coccidioidomycosis.
- To discuss uncomplicated and complicated forms of the disease.
- To address special considerations including fungemia, pregnancy, and organ transplantation.
Main Methods:
- Literature review focusing on coccidioidal infection.
- Analysis of primary, complicated, and residual pulmonary coccidioidomycosis.
- Inclusion of special populations and complications.
Main Results:
- Pulmonary coccidioidomycosis encompasses primary, complicated (e.g., severe pneumonia, ARDS), and residual (nodule, fibrosis) categories.
- Symptomatic disease often mimics influenza or pneumonia.
- Complicated forms include severe pneumonia, fibrocavitary disease, and empyema.
Conclusions:
- Effective management of pulmonary coccidioidomycosis depends on accurate classification into primary, complicated, or residual disease.
- Special populations like pregnant individuals and transplant recipients require tailored approaches.
- Understanding the spectrum of coccidioidal infection is crucial for patient outcomes.
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