{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:17:56Z","timestamp":1779931076099,"version":"3.53.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T00:00:00Z","timestamp":1569196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The care of primary pulmonary coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extrapulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.<\/jats:p>","DOI":"10.1093\/cid\/ciz933","type":"journal-article","created":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T19:27:37Z","timestamp":1568921257000},"page":"2008-2012","source":"Crossref","is-referenced-by-count":26,"title":["Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success?"],"prefix":"10.1093","volume":"70","author":[{"given":"John N","family":"Galgiani","sequence":"first","affiliation":[{"name":"Valley Fever Center for Excellence, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"},{"name":"Department of Medicine, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis E","family":"Blair","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil M","family":"Ampel","sequence":"first","affiliation":[{"name":"Valley Fever Center for Excellence, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"},{"name":"Department of Medicine, University of Arizona College of Medicine\u2013Tucson, Tucson, Arizona, USA"},{"name":"Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R","family":"Thompson","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,9,23]]},"reference":[{"key":"2020041501061018000_CIT0001","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00112-19","article-title":"Early events in coccidioidomycosis","author":"Donovan","year":"2019.","journal-title":"Clin Microbiol Rev"},{"key":"2020041501061018000_CIT0002","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.3201\/eid1407.070832","article-title":"Testing for coccidioidomycosis among patients with community-acquired pneumonia","volume":"14","author":"Chang","year":"2008","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0003","first-page":"217","article-title":"Increase in reported coccidioidomycosis\u2014United States, 1998\u20132011","volume":"62","author":"Centers for Disease Control and Prevention","year":"2013","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020041501061018000_CIT0004","doi-asserted-by":"crossref","first-page":"958","DOI":"10.3201\/eid1206.060028","article-title":"Coccidioidomycosis as a common cause of community-acquired pneumonia","volume":"12","author":"Valdivia","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0005","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3201\/eid1563.081007","article-title":"Coccidioidal pneumonia, Phoenix, Arizona, USA, 2000\u20132004","volume":"15","author":"Kim","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0006","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2020041501061018000_CIT0007","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3201\/eid2302.160505","article-title":"Risk factors for disseminated coccidioidomycosis, United States","volume":"23","author":"Odio","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0008","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.2105\/AJPH.36.12.1394","article-title":"Varieties of coccidioidal infection in relation to the epidemiology and control of the diseases","volume":"36","author":"Smith","year":"1946","journal-title":"Am J Public Health Nations Health"},{"key":"2020041501061018000_CIT0009","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofy210.397","article-title":"A reexamination of disseminated coccidioidomycosis: the natural history in the pre-antifungal era","author":"Bays","year":"2018"},{"key":"2020041501061018000_CIT0010","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/0002-9343(59)90046-4","article-title":"The use of amphotericin B in the treatment of coccidioidal disease","volume":"27","author":"Winn","year":"1959","journal-title":"Am J Med"},{"key":"2020041501061018000_CIT0011","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/S0025-7125(16)33522-2","article-title":"Coccidioidomycosis and amphotericin B","volume":"47","author":"Winn","year":"1963","journal-title":"Med Clin North Am"},{"key":"2020041501061018000_CIT0012","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1093\/cid\/cir466","article-title":"Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis","volume":"53","author":"Thompson","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020041501061018000_CIT0013","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1086\/595687","article-title":"Factors and outcomes associated with the decision to treat primary pulmonary coccidioidomycosis","volume":"48","author":"Ampel","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2020041501061018000_CIT0014","doi-asserted-by":"crossref","first-page":"983","DOI":"10.3201\/eid2006.131842","article-title":"Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis","volume":"20","author":"Blair","year":"2014","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0015","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/mmy\/myy029","article-title":"Current concepts and future directions in the pharmacology and treatment of coccidioidomycosis","volume":"57","author":"Thompson","year":"2019","journal-title":"Med Mycol"},{"key":"2020041501061018000_CIT0016","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1093\/jac\/dky501","article-title":"Tolerability of long-term fluconazole therapy","volume":"74","author":"Davis","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2020041501061018000_CIT0017","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.3201\/eid2509.190023","article-title":"Delays in coccidioidomycosis diagnosis and associated healthcare utilization, Tucson, Arizona, USA","volume":"25","author":"Donovan","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0018","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.3201\/eid2508.190019","article-title":"Delays in the diagnosis of coccidioidomycosis and their relationship to healthcare utilization","volume":"25","author":"Ginn","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2020041501061018000_CIT0019","doi-asserted-by":"crossref","first-page":"5553","DOI":"10.1128\/IAI.00885-08","article-title":"Vaccine-induced cellular immune responses differ from innate responses in susceptible and resistant strains of mice infected with Coccidioides posadasii","volume":"76","author":"Shubitz","year":"2008","journal-title":"Infect Immun"},{"key":"2020041501061018000_CIT0020","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1093\/clinids\/4.3.656","article-title":"Tissue eosinophilia in human coccidioidomycosis","volume":"4","author":"Echols","year":"1982","journal-title":"Rev Infect Dis"},{"key":"2020041501061018000_CIT0021","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/978-1-4757-1712-9_7","article-title":"Pathology of coccidioidomycosis.","volume-title":"Coccidioidomycosis: a text","author":"Huntington","year":"1980"},{"key":"2020041501061018000_CIT0022","first-page":"439","article-title":"Immune complexes in coccidioidomycosis. Correlation with disease involvement","volume":"126","author":"Cox","year":"1982","journal-title":"Am Rev Respir Dis"},{"key":"2020041501061018000_CIT0023","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1128\/iai.28.3.944-949.1980","article-title":"Complement activation by Coccidioides immitis: in vitro and clinical studies","volume":"28","author":"Galgiani","year":"1980","journal-title":"Infect Immun"},{"key":"2020041501061018000_CIT0024","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1080\/13693780600794533","article-title":"Fatigue in coccidioidomycosis. Quantification and correlation with clinical, immunological, and nutritional factors","volume":"44","author":"Muir Bowers","year":"2006","journal-title":"Med Mycol"},{"key":"2020041501061018000_CIT0025","first-page":"100","article-title":"Coccidioidomycosis at a university health service","volume":"131","author":"Kerrick","year":"1985","journal-title":"Am Rev Respir Dis"},{"key":"2020041501061018000_CIT0026","article-title":"Oxygen consumption deficits in patients with residual fatigue after primary coccidioidomycosis","volume":"4:ofx136","author":"Ganley","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2020041501061018000_CIT0027","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1128\/CMR.3.3.247","article-title":"Serology of coccidioidomycosis","volume":"3","author":"Pappagianis","year":"1990","journal-title":"Clin Microbiol Rev"},{"key":"2020041501061018000_CIT0028","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/jama.1956.02960420026008","article-title":"Pattern of 39 500 serologic tests in coccidioidomycosis","volume":"160","author":"Smith","year":"1956","journal-title":"J Am Med Assoc"},{"key":"2020041501061018000_CIT0029","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01318-18","article-title":"Coccidioidomycosis complement fixation titer trends in the age of antifungals","volume":"56","author":"McHardy","year":"2018","journal-title":"J Clin Microbiol"},{"key":"2020041501061018000_CIT0030","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1086\/516115","article-title":"Prediction of relapse after treatment of coccidioidomycosis","volume":"25","author":"Oldfield","year":"1997","journal-title":"Clin Infect Dis"},{"key":"2020041501061018000_CIT0031","first-page":"440","article-title":"A comparison of coccidioidin and spherulin skin testing in the diagnosis of coccidioidomycosis","volume":"124","author":"Gifford","year":"1981","journal-title":"Am Rev Respir Dis"},{"key":"2020041501061018000_CIT0032","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s11046-019-00356-5","article-title":"An analysis of skin test responses to spherulin-based coccidioidin (Spherusol) among a group of subjects with various forms of active coccidioidomycosis","volume":"184","author":"Ampel","year":"2019","journal-title":"Mycopathologia"},{"key":"2020041501061018000_CIT0033","doi-asserted-by":"crossref","DOI":"10.1093\/mmy\/myz099","article-title":"Coccidioides (spherulin) skin testing in patients with pulmonary coccidioidomycosis in an endemic region","author":"Mafi","year":"2019","journal-title":"Med Mycol"},{"key":"2020041501061018000_CIT0034","author":"Valley Fever Center for Excellence"},{"key":"2020041501061018000_CIT0035","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.02634-16","article-title":"Large-scale evaluation of in vitro amphotericin B, triazole, and echinocandin activity against coccidioides species from U.S. institutions","volume":"61","author":"Thompson","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2020041501061018000_CIT0036","doi-asserted-by":"crossref","first-page":"676","DOI":"10.7326\/0003-4819-133-9-200011070-00009","article-title":"Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Mycoses Study Group","volume":"133","author":"Galgiani","year":"2000","journal-title":"Ann Intern Med"},{"key":"2020041501061018000_CIT0037","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.00999-18","article-title":"The orotomide olorofim is efficacious in an experimental model of central nervous system coccidioidomycosis","volume":"62","author":"Wiederhold","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2020041501061018000_CIT0038","doi-asserted-by":"crossref","first-page":"747","DOI":"10.3109\/13693786.2013.770610","article-title":"Efficacy of nikkomycin Z for respiratory coccidioidomycosis in naturally infected dogs","volume":"51","author":"Shubitz","year":"2013","journal-title":"Med Mycol"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciz933\/30341450\/ciz933.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/70\/9\/2008\/33045658\/ciz933.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/70\/9\/2008\/33045658\/ciz933.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T02:37:03Z","timestamp":1664419023000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/70\/9\/2008\/5572562"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,23]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9,23]]},"published-print":{"date-parts":[[2020,4,15]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciz933","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5,1]]},"published":{"date-parts":[[2019,9,23]]}}}