Coccidioidomycosis natural history

Coccidioidomycosis is usually a self-limited mild clinical illness. A large proportion of individuals are clinically infected without any manifestations and are thus completely asymptomatic. The remaining develop a mild pulmonary illness which in most cases is self-limited requiring no treatment, and even those cases which do require treatment have an excellent prognosis. The mortality rate is currently <0.07%. If left untreated in patients with weakened immune systems, the infection spreads throughout the body. The clinical picture may be complicated due to widespread dissemination of the organism leading to a number of complications pleural effusion, relapse, pyopneumothorax, hemoptysis, and pleuritic chest pain, synovitis and osteomyelitis.

• Coccidioidomycosis is usually a self-limited mild clinical illness.
• A large proportion of individuals are clinically infected without any manifestations and are thus completely asymptomatic.
• The remaining develop a mild pulmonary illness which in most cases is self-limited requiring no treatment, and even those cases which do require treatment have an excellent prognosis.
• It is often misdiagnosed as community-acquired pneumonia. There are several cutaneous manifestations such as erythema multiforme and erythema nodosum, it may even cause arthritis and arthralgias.
• If left untreated in patients with weakened immune systems, the infection spreads throughout the body.
• The disseminated form of Coccidioidomycosis can devastate the body, causing skin ulcers, abscesses, bone lesions, swollen joints with severe pain, pericarditis, prostatitis,urinary tract infection, and meningitis, which can lead to death.^[1]

Complications of coccidioidomycosis include:^[2][3]

• Pleural effusion
• Return of the infection (relapse)
• Meningitis
• Pulmonary cavities, that may rupture leading to pyopneumothroax, otherwise causing persistent cough, hemoptysis, and pleuritic chest pain
• Synovitis and osteomyelitis

The prognosis of Coccidioidomycosis is good in immunocompetent patients. It is self-limited in most of the patients and recovery is without any complications. The mortality rate is currently <0.07%. Approximately less than 1 % of patients develop disseminated coccidioidomycosis.

Factors associated with poor prognosis:

• HIV disease,with low CD4 count (<250)
• Late stage Pregnancy( third trimester)
• Organ transplantation
• Immunosuppressant therapy ^[4]

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