THORACIC AND RESPIRATORYDISORDERSSYMPTOMS/EXAM
■ Infection can be clinically silent.
■ Primary infection is characterized by cough and flulike symptoms.
■ Chronic illness typically manifests as TB-like symptoms (weight loss,
fevers, malaise, hemoptysis).
DIAGNOSIS
■ CXR: Often normal or showing isolated hilar adenopathy in primary
infection; scattered nodules (histoplasmomas) or upper lobe cavitary
lesions may develop in chronic illness
■ Positive fungal stains, cultures, antigen detection, or serologic testing is
confirmative.
TREATMENT
Antifungals are reserved for patients with moderately severe acute disease or
those with chronic illness.
COMPLICATIONS
■ Disseminated disease with multiorgan involvement
■ Mediastinal fibrosis (SVC syndrome, airway obstruction, dysphagia)
COCCIDIOMYCOSIS(VALLEYFEVER)
The fungus Coccidioides immitisis endemic to the arid soils of the southwest-
ern United States. Infection results from inhalation of dust from disturbed soil.
Severe or disseminated infection is more common in immunocompromised
patients.
SYMPTOMS/EXAM
■ Primary infection is clinically silent in most individuals.
■ Classic presentation is triad of pneumonitis, rash (erythema nodosum),
and arthritis.
■ Cough, fevers/chills, and flulike symptoms are common.
DIAGNOSIS
■ CXR:In acute infection it may be normal or show hilar adenopathy, thin-
walled cavities, or unilateral infiltrates.
■ Positive fungal stains, cultures, or serologic testing is confirmative.
TREATMENT
Ketoconazole, fluconazole, itraconazole; amphotericin B only in severe cases
COMPLICATIONS
Disseminated disease with multiorgan involvement
BLASTOMYCOSIS
The fungus Blastomyces dermatidesis found in the Midwest andthe south-
eastern United States.
SYMPTOMS/EXAM
■ Many cases are subclinical.
■ Fever, cough, headache, dyspnea