Coccidioidomycosis — SCE Infectious Diseases MCQ
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Correct answer: D — Observation with serial serology; antifungal therapy is not required for uncomplicated primary coccidioidomycosis
This is uncomplicated primary coccidioidomycosis acquired in an endemic area of the south-western USA. Erythema nodosum and arthralgia are early immune-mediated manifestations and do not, by themselves, indicate disseminated fungal disease. He is young, systemically well, has no respiratory symptoms, no immunosuppression or major comorbidity, and a low complement-fixation titre of 1:4. Current specialist guidance recommends patient education, close clinical follow-up and supportive care/observation for mild or non-debilitating primary pulmonary coccidioidomycosis; antifungal treatment is reserved for severe or debilitating illness, extensive pulmonary disease, high/rising titres, significant comorbidity or immunosuppression, pregnancy, or proven disseminated disease. Therefore the best answer is observation with serial serology rather than fluconazole, itraconazole, voriconazole or amphotericin.
Reference: Infectious Diseases Society of America. Clinical Practice Guideline for the Treatment of Coccidioidomycosis. 2016. https://www.idsociety.org/practice-guideline/coccidioidomycosis/