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Î The development of a febrile pulmonary illness during pregnancy
in a woman residing in the coccidioidal endemic region or with
an appropriate travel history should be evaluated for active
coccidioidomycosis, including obtaining a chest radiograph and
coccidioidal serology and cultures (S-M).
For Neonates
Î The IDSA recommends against coccidioidal serologic tests for infants
during the first 3 months of life. Positive tests should be interpreted
with caution during the first year of life (S-M).
Î Empiric therapy with fluconazole at 6–12 mg/kg daily is recommended
for infants suspected of having coccidioidomycosis and should be
continued until the diagnosis has been ruled out (S-L).
Î Breastfeeding is NOT recommended for mothers on azole antifungals
other than fluconazole (S-M).
HIV Co-Infection
Î Antifungal prophylaxis is NOT recommended to prevent
coccidioidomycosis in patients infected with HIV living in coccidioidal-
endemic regions (S-M).
Î Antifungal therapy is recommended for all patients with HIV infection
with clinical evidence of coccidioidomycosis and a peripheral blood
CD4+ T-lymphocyte count <250 cells/µL (S-M).
Î Antifungal therapy should be continued as long as the peripheral
CD4+ T-lymphocyte count remains <250 cells/µL (S-L).
Î For patients with peripheral CD4+ T-lymphocyte counts ≥250 cells/µL,
clinical management of coccidioidomycosis should occur in the same
manner as for patients without HIV infection, including discontinuing
antifungal therapy in appropriate situations (S-M).
Î Within coccidioidal-endemic regions, patients should receive yearly
serologic screening and chest radiography for coccidioidomycosis
(S-L).
Î Outside coccidioidal-endemic regions, serologic screening is NOT
recommended (S-M).
Î Although data are lacking, pediatric patients with HIV infection and
coccidioidomycosis should be managed in a manner similar to adult
patients (S-VL).
Î Initiation of potent antiretroviral therapy (ART) should not be delayed
because of the concern about coccidioidal immune reconstitution
inflammatory syndrome (S-L).
