Coccidioidomycosis in Persons Infected with HIV Type 1

Abstract

Coccidioidomycosis is a recognized opportunistic infection among persons infected with human immunodeficiency virus (HIV). Early in the HIV epidemic, most cases presented as overwhelming diffuse pulmonary disease with a high mortality rate. Although these cases are still seen, patients without significant immunodeficiency frequently present with a community-acquired pneumonia syndrome. Diagnosis can be established by cytological staining, culture, or serologic testing. All patients with HIV infection and symptomatic coccidioidomycosis should be treated with antifungal therapy. Severe cases frequently require a combination of therapy with amphotericin B and a triazole antifungal. Therapy for at least 1 year is recommended, but for patients with a focal pulmonary infection and peripheral blood CD4 lymphocyte counts of >250 cells/microL, it may be reasonable to stop therapy after this time. Other manifestations of coccidioidomycosis require prolonged therapy, and life-long treatment is recommended for persons with meningitis.

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

“…Serologic tests may not be positive during very early infection and have reduced sensitivity for use on immunosuppressed persons (152). Testing for coccidioidal antigens is therefore an attractive potential method of diagnosis.…”

Coccidioidomycosis: A review and update

“…160,162,163 HIV patients, allograft recipients, and other immunosuppressed patients may be treated with systemic antifungal agents. Specific ethnic backgrounds, such as Filipino or African American ancestry, may also be considered a risk factor for dissemination.…”

AIDS and Opportunistic Infections

“…The other findings include nodules, adenopathy, cavities and pleural effusion. The mainstays of diagnosis of coccidioidomycosis are serologic testing, histopathological identification, and culture (Ampel, 2005). In cases of pulmonary coccidioidomycosis, results of culture of respiratory specimens (sputum, BAL fluid, or transbronchial biopsy) are frequently positive.…”