Update on the diagnosis of pulmonary coccidioidomycosis

Joshua Malo, Carmen Luraschi-Monjagatta, Donna M. Wolk, R. Thompson, Chadi Hage, Kenneth S. Knox

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Coccidioidomycosis is a common cause of community-acquired pneumonia in the southwest United States, Mexico, and South America. The disease has seen a marked increase in incidence in the western United States in the last decade and can be acquired by individuals who travel even briefly through an endemic area, presenting a diagnostic dilemma for clinicians who are not familiar with the disease. The clinical and radiographic manifestations of pulmonary coccidioidomycosis often mimic those of other causes of pneumonia. However, because treatment recommendations and the potential for chronic sequelae of acute infection differ substantially from those for bacterial community-acquired pneumonia, accurate, timely diagnosis of coccidioidomycosis is paramount. A number of diagnostic tests are available with varying sensitivity and specificity, making the approach complex. Radiographic features, although nonspecific, sometimes demonstrate patterns more suggestive of coccidioidomycosis than bacterial community-acquired pneumonias. A routine blood count may reveal eosinophilia. Serologic testing is used most widely but may be negative early in the course of disease, potentially leading to misdiagnosis with subsequent inappropriate treatment and follow-up. The sensitivity of serologic testing is lower in immunocompromised patients, a population at the highest risk for developing severe disease. When clinically appropriate, other biologic specimens, such as sputum, bronchoalveolar lavage fluid, or lung biopsies, may allow for rapid, definitive diagnosis. In light of the significantly increased incidence and complexities in diagnosis of coccidioidomycosis, we examine the diagnostic approach and provide examples of classic clinical and radiographic presentations, discuss the utility of serologic testing, and suggest algorithms that may aid in the diagnosis.

Original languageEnglish
Pages (from-to)243-253
Number of pages11
JournalAnnals of the American Thoracic Society
Volume11
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Coccidioidomycosis
Pneumonia
Lung
South America
Incidence
Bronchoalveolar Lavage Fluid
Immunocompromised Host
Eosinophilia
Mexico
Diagnostic Errors
Sputum
Routine Diagnostic Tests
Biopsy
Sensitivity and Specificity
Therapeutics
Infection

Keywords

  • Cavitary lung diseases
  • Coccidioidomycosis
  • Eosinophilic lung diseases
  • Fungal lung diseases
  • Serologic tests

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Malo, J., Luraschi-Monjagatta, C., Wolk, D. M., Thompson, R., Hage, C., & Knox, K. S. (2014). Update on the diagnosis of pulmonary coccidioidomycosis. Annals of the American Thoracic Society, 11(2), 243-253. https://doi.org/10.1513/AnnalsATS.201308-286FR

Update on the diagnosis of pulmonary coccidioidomycosis. / Malo, Joshua; Luraschi-Monjagatta, Carmen; Wolk, Donna M.; Thompson, R.; Hage, Chadi; Knox, Kenneth S.

In: Annals of the American Thoracic Society, Vol. 11, No. 2, 2014, p. 243-253.

Research output: Contribution to journalArticle

Malo, J, Luraschi-Monjagatta, C, Wolk, DM, Thompson, R, Hage, C & Knox, KS 2014, 'Update on the diagnosis of pulmonary coccidioidomycosis', Annals of the American Thoracic Society, vol. 11, no. 2, pp. 243-253. https://doi.org/10.1513/AnnalsATS.201308-286FR
Malo, Joshua ; Luraschi-Monjagatta, Carmen ; Wolk, Donna M. ; Thompson, R. ; Hage, Chadi ; Knox, Kenneth S. / Update on the diagnosis of pulmonary coccidioidomycosis. In: Annals of the American Thoracic Society. 2014 ; Vol. 11, No. 2. pp. 243-253.
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