Risk factors for coccidioidomycosis:
(1) residence in an endemic area
(2) a CD4 cell count < 200 per µL
(3) black race
(4) history of oropharyngeal or esophageal thrush (candidiasis)
where:
• The length of time in an endemic area required for exposure may vary on the several factors. Cases of coccidioidomycosis have occurred in people who have never been to an endemic area but who have been exposed to fomites from these areas.
• Since Filipinos and other Asians may have a higher risk of disseminated disease, they might also be included as having a risk factor. Apparently the number in the study population was too small for evaluation.
Factors associated with reduced risk for disease:
(1) azole (ketoconazole, itraconazole) drug therapy in patients with a history of thrush
(2) anti-HIV drug therapy (protease inhibitors)
Patients with risk factors should be considered for prophylaxis with an azole drug if the CD4 count is < 200 per µL.
NOTE: Many prophylactic regimens for opportunistic infections are now being stopped if the CD4 count is sufficiently high. I would imagine this will also hold for coccidioidomycosis.
