Coccidioidomycosis.

Although rapid population growth in the Southwestern United States and travel to and through the area are increasing the potential for exposure to Coccidioides immitis, prevalence rates have declined in some endemic areas, probably because of environmental factors. With the iatrogenic immunosuppression of organ transplantation and the immunosuppression inherent in AIDS, more opportunistic infections with this organism are to be expected. The variety of cutaneous manifestations continues to challenge the dermatologist's acumen. Spherule-derived coccidioidin is an improved epidemiologic tool, and serodiagnostic techniques are easier to perform and are useful in the management of dissemination. While amphotericin B remains the standard, ketoconazole has found a definite role in the treatment of this disease in many patients. Itraconazole, now under investigation, appears very promising. Morbidity and mortality from disseminated disease appear to be declining. With current diagnostic and therapeutic methods, the prognosis for survival in immunocompetent patients is excellent.