Estimates of annual infections. 6

Reasons for under reporting of Valley Fever. 6

The value of identifying patients with early coccidioidal infections. 7

Primary management of coccidioidomycosis. 8

Section 3: Consider the Diagnosis of Valley Fever 10

Spectrum of clinical manifestations for Valley Fever 10

Selecting patients for evaluation 11

Section 4: Order the Right Tests 12

Detection of anti-coccidioidal antibodies in serum. 12

Overview 12

Tube precipitin (TP) antibodies 12

Complement fixing (CF) antibodies 13

Immunodiffusion tests (IDTP, IDCF) 13

Enzyme-linked immunoassays (EIA) 13

Latex tests 14

Cultures for C. immitis 14

Overview 14

Handling of specimens 14

Evaluation by the laboratory 14

Skin testing 15

Overview 15

Interpretation 15

Section 5: Check for Risk 16

Immunosuppression. 16

Diabetes mellitus 16

Pregnancy 16

Other risk factors 16

Section 6: Check for Progressive Pulmonary Syndromes or Disseminated Diseases 17

Pulmonary Complications 17

Persistent or slowly resolving pneumonia 17

Pulmonary cavitation 17

Chronic fibrocavitary pneumonia 17

Diffuse fulminant pneumonia 18

Extrapulmonary dissemination 18

Section 7: Management Strategies for Uncomplicated Early Infections 19

Health education and recommendations to the patient and family 20

Frequency of follow-up health care visits 20

Monitors of the course of infection. 21

Generally systemic signs 21

Laboratory studies 21

Chest radiographs 21

Antifungal therapy 21

Section 8: Selected References