Not everyone with coccidioidomycosis requires antifungal therapy. Ampfel et al listed factors which may influence the decision to treat or not. The authors are from the University of Arizona and the Southern Arizona Veterans Affairs Health Care System in Tucson.


Disease severity was determined by a modified score from the NAIAD Mycoses Study Group (see 23.47)


Factors associated with a decision to treat a patient with coccidioidomycosis:

(1) severe disease, indicated by a high symptom score and/or total score

(2) HIV disease or immunosuppression

(3) isolation of coccidioidomycosis on fungal culture

(4) development of progressive, disseminated disease or other complications


One risk group for complications includes patients who have antifungal therapy stopped after initial treatment. It is important to make sure that a patient who is being treated receives an adequate therapeutic course and that the patient has long-term followup to detect recurrence.


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