Coccidioidomycosis
Prevention of Exposure
Although HIV-infected persons living in or visiting areas in which
coccidioidomycosis is endemic cannot completely avoid exposure to
Coccidioides immitis, they should, when possible, avoid activities
associated with increased risk (e.g., those involving extensive exposure
to disturbed native soil, for example, at building excavation sites or during
dust storms).
Routine skin testing with coccidioidin (spherulin) in coccidioidomycosis-endemic areas is not predictive of disease and should not be performed.
No recommendation can be made regarding routine chemoprophylaxis for HIV-infected persons who live in coccidioidomycosis-endemic areas or for skin test-positive persons who live in areas where coccidioidomycosis is not endemic.
Prevention of Recurrence
Patients who complete initial therapy for coccidioidomycosis should be
administered lifelong systemic suppressive treatment. Fluconazole is
the preferred agent; alternative drugs include itraconazole and amphotericin
B.
Notes:
Pediatric Note
Although no specific data are available regarding coccidioidomycosis
in HIV-infected children, it is reasonable to administer lifelong suppressive
therapy after an acute episode of the disease.
Note Regarding Pregnancy
(6) Because of the risk to maternal health posed by coccidioidomycosis,
prophylaxis against recurrent coccidioidomycosis is indicated during pregnancy.
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