Coccidioidomycosis.

Coccidioidomycosis is a fungal infection caused by Coccidiodes. The fungus has a limited geographic distribution but the disease can be seen anywhere. Primary infection is usually self-limited; however, when a large dose of fungus is inhaled or in an immunosuppressed host, the patient may develop overwhelming infection, including ARDS, in a brief period. While serodiagnosis can help to suspect the diagnosis, particularly in the setting of overwhelming disease, diagnostic efforts should focus on identifying the organism in body fluids or tissues. Several treatment options are available. Amphotericin B was the drug of choice for decades when there were no alternatives. Triazoles, fluconazole and itraconazole, are very effective and much less toxic.