Coccidiomycosis - Diagnosis Diagnosis: • Mildly elevated peripheral WBC, Eosinophilia (25%), Elevated ESR, Procalcitonin normal (95%) • CXR: Unilateral dense infiltrate with ipsilateral hilar adenopathy, Preference for upper lobes (unlike bacterial), Nodules/Cavities (4-8%), Empyema (rupture of cavity into pleural space) • ElA for Cocci IgM & IgG (Sensitive) • Immunodiffusion for Cocci Ab (Specific, but only qualitative, Confirm when ElA is positive) • Complement Fixation (Quantitative to trend response to treatment, Performed in response to positive immunodiffusion test) • Culture (ElA may be negative for the first weeks after exposure, 3-7 days to grow culture) • BAL (Washings are stained for cytological examination & may reveal spherules) Disseminated • Meninges, skeleton, skin & joints - Can involve liver, pancreas, pericardium, bone marrow & genitourinary system • Urine & Blood & CSF (Cocci Ag, Elevated Beta D Glucan in blood/CSF) • Biopsy & Debridement • Lumbar Puncture only if CNS symptoms SCVMC Internal Medicine @SCVMCMed #Coccidioidomycosis #cocci #Coccidioides #Diagnosis #workup #infectiousdiseases
