Coccidioidomycosis - disseminated

Alternative names
Systemic coccidioidomycosis

Coccidioidomycosis is a a disease caused by breathing in a fungus (Coccidioides immitis) found in the soil in certain parts of the southwestern U.S., Mexico, and Central and South America. It spreads through the bloodstream to involve many organs.

Causes, incidence, and risk factors

Coccidioidomycosis is caused by breathing in the spores of a fungus in desert regions. About 60% of acute infections cause no symptoms and are only recognized by a positive coccidioidin skin test. In the remaining 40%, symptoms range from mild to severe.

In disseminated disease, extension of infection to the bones, lungs, liver, meninges, brain, skin, heart, and pericardium (sac around the heart) may take place.

Meningitis occurs in 30-50% of cases of disseminated disease. Immunodeficient (immunosuppressed) people, including those with HIV infection, diabetics, and pregnant women of any race are more prone to the disease. Recent travel to or residence in southwestern deserts of the U.S. is a risk factor.


  • cough  
  • fever  
  • chills  
  • headache  
  • muscle stiffness  
  • muscle aches  
  • neck stiffness or shoulder stiffness  
  • change in mental status  
  • sensitivity to light

Additional symptoms that may be associated with this disease:

  • joint swelling  
  • joint pain  
  • skin reaction (erythema nodosum)  
  • arthritis  
  • ankle, feet, and leg swelling

Signs and tests

  • sputum smear (KOH test)  
  • sputum culture  
  • serum coccidioides complement fixation titer  
  • coccidioidin skin test  
  • CBC with differential  
  • chest X-ray  
  • biopsy of tissue in area of disseminated disease       o bone marrow biopsy       o liver biopsy       o open lung biopsy       o skin lesion biopsy  
  • changes in neurological examination


Bed rest and supportive treatment, especially improved nutrition, are indicated. Antifungal medications are prescribed to treat the infection.

Expectations (prognosis)

People with disseminated disease have a high death rate. The course may be rapid for immunosuppressed patients.


This can be a fatal disorder.

Calling your health care provider

Call for an appointment with your health care provider if symptoms of disseminated coccidioidomycosis develop.


General maintenance of good health will limit the disease to a harmless pulmonary form. Prevention of AIDS or other causes of impaired immune system will generally prevent the more severe forms of the disease.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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