{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T02:59:18Z","timestamp":1772679558089,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of California Los Angeles","award":["1U19AI166059"],"award-info":[{"award-number":["1U19AI166059"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Coccidioidomycosis (CM) is an endemic disease in the western United States, northern Mexico, and Central and South America. The severity of coccidioidal infection is highly variable, with potential factors including comorbidities and the patient\u2019s innate and adaptive immune response. Based on data from a predominantly healthy and mainly Caucasian male survey conducted nearly a century ago, approximately 60% of infections are asymptomatic, with an estimated 40% of people experiencing some respiratory symptoms; with 10% of those diagnosed with CM. Disseminated disease occurs in approximately 1% of cases and can involve the meninges and, potentially, any place in the body. It is not yet fully understood why some people experience severe disease while many people do not; it is understood that the immune response has a major role. Immunomodulators, including dupilumab and interferon-gamma (IFN-\u03b3), have shown promise in treating patients with disseminated infection. This article summarizes the latest genetic and immunologic evidence demonstrating immune dysfunction. Immunomodulators and potential therapeutic strategies based on the above are reviewed.<\/jats:p>","DOI":"10.3390\/jof11090664","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T07:51:46Z","timestamp":1757577106000},"page":"664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Use of Genetics and Immunology in the Diagnosis and Care of Advanced Coccidioidomycosis: Where Are We Going?"],"prefix":"10.3390","volume":"11","author":[{"given":"Kavitha","family":"Thiagarajan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikha","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Kern Medical, Bakersfield, CA 93306, USA"},{"name":"Valley Fever Institute at Kern Medical, Bakersfield, CA 93306, USA"},{"name":"Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0787-6578","authenticated-orcid":false,"given":"Rob","family":"Purdie","sequence":"additional","affiliation":[{"name":"MyCARE Foundation, Colorado Springs, CO 80906, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Torres","sequence":"additional","affiliation":[{"name":"Valley Fever Institute at Kern Medical, Bakersfield, CA 93306, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Royce H.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Kern Medical, Bakersfield, CA 93306, USA"},{"name":"Valley Fever Institute at Kern Medical, Bakersfield, CA 93306, USA"},{"name":"Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4490-5595","authenticated-orcid":false,"given":"Manish J.","family":"Butte","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, UCLA, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.3201\/eid2206.151565","article-title":"Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides","volume":"22","author":"Teixeira","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1093\/mmy\/myy095","article-title":"Update on the Epidemiology of Coccidioidomycosis in the United States","volume":"57","author":"McCotter","year":"2019","journal-title":"Med. Mycol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kirkland, T.N., Stevens, D.A., Hung, C.-Y., Beyhan, S., Taylor, J.W., Shubitz, L.F., Duttke, S.H., Heidari, A., Johnson, R.H., and Deresinski, S.C. (2022). Coccidioides Species: A Review of Basic Research: 2022. J. Fungi, 8.","DOI":"10.3390\/jof8080859"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1080\/21505594.2019.1589363","article-title":"The Mysterious Desert Dwellers: Coccidioides Immitis and Coccidioides Posadasii, Causative Fungal Agents of Coccidioidomycosis","volume":"10","author":"Kollath","year":"2019","journal-title":"Virulence"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/archinte.1938.00180160132011","article-title":"Coccidioides Infection (Coccidioidomycosis): II. the Primary Type of Infection","volume":"62","author":"Dickson","year":"1938","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2513572","DOI":"10.1001\/jamanetworkopen.2025.13572","article-title":"Estimated Burden of Coccidioidomycosis","volume":"8","author":"Williams","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.2147\/CLEP.S34434","article-title":"Coccidioidomycosis: Epidemiology","volume":"185","author":"Thompson","year":"2013","journal-title":"Clin. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/cid\/cir410","article-title":"Coccidioidomycosis During Pregnancy: A Review and Recommendations for Management","volume":"53","author":"Bercovitch","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","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. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Galgiani, J.N., Hsu, A.P., Powell, D.A., Vyas, J.M., and Holland, S.M. (2023). Genetic and Other Determinants for the Severity of Coccidioidomycosis: A Clinician\u2019s Perspective. J. Fungi, 9.","DOI":"10.3390\/jof9050554"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e159491","DOI":"10.1172\/jci.insight.159491","article-title":"Immunogenetics Associated with Severe Coccidioidomycosis","volume":"7","author":"Hsu","year":"2022","journal-title":"JCI Insight"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1056\/NEJMoa2000024","article-title":"Disseminated Coccidioidomycosis Treated with Interferon-\u03b3 and Dupilumab","volume":"382","author":"Tsai","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"308","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":"ref_14","doi-asserted-by":"crossref","unstructured":"Stevens, D.A., Martinez, M., Sass, G., Pappagianis, D., Doherty, B., Kutsche, H., and McGuire, M. (2020). Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis. J. Fungi, 6.","DOI":"10.3390\/jof6030125"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e2746","DOI":"10.1093\/cid\/ciaa1205","article-title":"Comparison of a Novel Rapid Lateral Flow Assay to Enzyme Immunoassay Results for Early Diagnosis of Coccidioidomycosis","volume":"73","author":"Donovan","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1093\/cid\/ciad619","article-title":"Clinical Testing Guidance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis in Patients With Community-Acquired Pneumonia for Primary and Urgent Care Providers","volume":"78","author":"Smith","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1136\/jim-2020-001655","article-title":"Coccidioidomycosis: A Review","volume":"69","author":"Johnson","year":"2021","journal-title":"J. Investig. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1513\/AnnalsATS.201308-286FR","article-title":"Update on the Diagnosis of Pulmonary Coccidioidomycosis","volume":"11","author":"Malo","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"305","DOI":"10.7326\/0003-4819-124-3-199602010-00004","article-title":"Is It Ever Safe To Stop Azole Therapy for Coccidioides Immitis Meningitis?","volume":"124","author":"Dewsnup","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7326\/0003-4819-119-1-199307010-00005","article-title":"Fluconazole Therapy for Coccidioidal Meningitis","volume":"119","author":"Galgiani","year":"1993","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Maertens, J.A., Thompson, G.R., Spec, A., Donovan, F.M., Hammond, S.P., Bruns, A.H.W., Rahav, G., Shoham, S., Johnson, R., and Rijnders, B. (2025). Olorofim for the treatment of invasive fungal diseases in patients with few or no therapeutic options: A single-arm, open-label, phase 2b study. Lancet Infect. Dis., Epub ahead of print.","DOI":"10.1016\/S1473-3099(25)00224-5"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2324709618813178","DOI":"10.1177\/2324709618813178","article-title":"Crescendo Transient Ischemic Attacks Due to Basilar Coccidioidal Meningitis With Coccidioma","volume":"6","author":"Heidari","year":"2018","journal-title":"J. Investig. Med. High Impact Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.amjmed.2018.09.020","article-title":"Corticosteroids in the Management of Severe Coccidioidomycosis","volume":"132","author":"Chang","year":"2019","journal-title":"Am. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11910-018-0824-8","article-title":"Coccidioidal Meningitis: A Review on Diagnosis, Treatment, and Management of Complications","volume":"18","author":"Johnson","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1055\/s-0031-1295723","article-title":"Pulmonary Coccidioidomycosis","volume":"32","author":"Thompson","year":"2011","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1016\/j.clinthera.2019.08.011","article-title":"Host\u2013Pathogen Interactions in Coccidioidomycosis: Prognostic Clues and Opportunities for Novel Therapies","volume":"41","author":"Krogstad","year":"2019","journal-title":"Clin. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wiesner, D.L., Specht, C.A., Lee, C.K., Smith, K.D., Mukaremera, L., Lee, S.T., Lee, C.G., Elias, J.A., Nielsen, J.N., and Boulware, D.R. (2015). Chitin Recognition via Chitotriosidase Promotes Pathologic Type-2 Helper T Cell Responses to Cryptococcal Infection. PLoS Pathog., 11.","DOI":"10.1371\/journal.ppat.1004701"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/nri1745","article-title":"Dectin-1: A Signalling Non-TLR Pattern-Recognition Receptor","volume":"6","author":"Brown","year":"2006","journal-title":"Nat. Rev. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1128\/IAI.73.3.1553-1560.2005","article-title":"Innate Immunity to the Pathogenic Fungus Coccidioides posadasii Is Dependent on Toll-Like Receptor 2 and Dectin-1","volume":"73","author":"Viriyakosol","year":"2005","journal-title":"Infect. Immun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1038\/s41577-022-00826-w","article-title":"Immune Responses to Human Fungal Pathogens and Therapeutic Prospects","volume":"23","author":"Lionakis","year":"2023","journal-title":"Nat. Rev. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Meloun, A., and Le\u00f3n, B. (2023). Sensing of Protease Activity as a Triggering Mechanism of Th2 Cell Immunity and Allergic Disease. Front. Allergy, 4.","DOI":"10.3389\/falgy.2023.1265049"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1038\/s41586-022-05005-4","article-title":"Secreted Fungal Virulence Effector Triggers Allergic Inflammation via TLR4","volume":"608","author":"Dang","year":"2022","journal-title":"Nature"},{"key":"ref_33","first-page":"194","article-title":"Immunoglobulin E in Coccidioidomycosis","volume":"123","author":"Cox","year":"1979","journal-title":"J. Immunol. Baltim. Md 1950"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1128\/iai.37.2.609-616.1982","article-title":"Specificity of Immunoglobulin E in Coccidioidomycosis and Correlation with Disease Involvement","volume":"37","author":"Cox","year":"1982","journal-title":"Infect. Immun."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/clinids\/18.4.627","article-title":"Disseminated Coccidioidomycosis Associated with Extreme Eosinophilia","volume":"18","author":"Harley","year":"1994","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"CIS2025abstract.132","DOI":"10.70962\/CIS2025abstract.132","article-title":"Immunomodulation in the Treatment of Disseminated Coccidioidomycosis","volume":"1","author":"Stephens","year":"2025","journal-title":"J. Hum. Immun."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Lee, P.P., and Lau, Y.-L. (2017). Cellular and Molecular Defects Underlying Invasive Fungal Infections\u2014Revelations from Endemic Mycoses. Front. Immunol., 8.","DOI":"10.3389\/fimmu.2017.00735"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Xia, L., Liu, X.-H., Yuan, Y., Lowrie, D.B., Fan, X.-Y., Li, T., Hu, Z.-D., and Lu, S.-H. (2022). An Updated Review on MSMD Research Globally and A Literature Review on the Molecular Findings, Clinical Manifestations, and Treatment Approaches in China. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.926781"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jinf.2011.07.006","article-title":"Two Cases Illustrating Successful Adjunctive Interferon-\u03b3 Immunotherapy in Refractory Disseminated Coccidioidomycosis","volume":"63","author":"Duplessis","year":"2011","journal-title":"J. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"bcr2014205681","DOI":"10.1136\/bcr-2014-205681","article-title":"Haemophagocytic Lymphohistiocytosis Associated with Coccidiomycosis","volume":"2014","author":"Ramsi","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1086\/382075","article-title":"Successful Treatment of a Critically Ill Patient with Disseminated Coccidioidomycosis, Using Adjunctive Interferon-\u03b3","volume":"38","author":"Kuberski","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s40265-017-0768-3","article-title":"Dupilumab: First Global Approval","volume":"77","author":"Shirley","year":"2017","journal-title":"Drugs"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"ofac097","DOI":"10.1093\/ofid\/ofac097","article-title":"Economic Burden of Fungal Diseases in the United States","volume":"9","author":"Benedict","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1175\/WCAS-D-20-0036.1","article-title":"Economic Valuation of Coccidioidomycosis (Valley Fever) Projections in the United States in Response to Climate Change","volume":"13","author":"Gorris","year":"2021","journal-title":"Weather Clim. Soc."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Wilson, L., Ting, J., Lin, H., Shah, R., MacLean, M., Peterson, M.W., Stockamp, N., Libke, R., and Brown, P. (2019). The Rise of Valley Fever: Prevalence and Cost Burden of Coccidioidomycosis Infection in California. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16071113"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/9\/664\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:38Z","timestamp":1760035418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/9\/664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jof11090664"],"URL":"https:\/\/doi.org\/10.3390\/jof11090664","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}