5
Figure 3. Coccidioidal Pneumonia
Culture and Histopathology
Î An alternative approach to diagnosing early coccidioidal infection
is to isolate the fungus in culture, which may be the only means of
establishing a diagnosis since serologic evidence may take weeks and
even months to develop.
Î The diagnosis of disseminated coccidioidomycosis should usually rely
on the histopathologic identification in, or fungal isolation from, an
extrapulmonary lesion.
• Needle aspiration has been a very valuable approach.
• One common exception is the diagnosis of coccidioidal meningitis (CM) as
discussed below.
Additional Evaluation at the Time of Initial Diagnosis
Î If a careful review of systems and physical examination do not identify
focal extrapulmonary problems, additional laboratory or imaging
evaluation is usually unnecessary to fully assess extent of disease.
In contrast, new or progressive focal signs or symptoms warrant
further assessment appropriate for the anatomic location to detect
dissemination.
