9
Management of Patients With Coccidioidomycosis in Special
At-Risk Populations
Î For the treatment of autologous or allogeneic hematopoietic stem cell
transplantation (HSCT) or solid organ transplant recipients with acute
or chronic pulmonary coccidioidomycosis who are clinically stable and
have normal renal function, the IDSA recommends initiating treatment
with fluconazole 400 mg daily or the equivalent dose based upon renal
function (S-L).
Î For the treatment of patients with very severe and/or rapidly
progressing acute pulmonary or disseminated coccidioidomycosis,
the IDSA recommends the use of AmB until the patient has stabilized,
followed by fluconazole (S-L).
Î For autologous or allogeneic HSCT or solid organ transplant recipients
with extrapulmonary coccidioidomycosis, the IDSA recommends the
same treatment as for non–transplant recipients (S-VL).
Î For allogeneic HSCT or solid organ transplant recipients with severe
or rapidly progressing coccidioidomycosis, the IDSA recommends
reduction of immunosuppression (without risking graft-vs-host disease
or organ rejection, respectively, whenever possible) until the infection
has begun to improve (S-VL).
Î Following initial treatment of active coccidioidomycosis, the IDSA
recommends that suppressive treatment be continued to prevent
relapsed infection (S-VL).
Î The IDSA recommends oral azole therapy for recipients of biological
response modifiers unless their coccidioidomycosis is severe
enough that intravenous AmB would otherwise be recommended
(refer to sections on pneumonia, soft tissue dissemination, skeletal
dissemination, and meningitis) (S-L).
Pregnant Women With Coccidioidomycosis and Their Neonates
During Pregnancy
Î The development of symptomatic coccidioidomycosis during
pregnancy should prompt consideration of starting administration of
antifungal therapy (S-M).
• For women who develop initial nonmeningeal coccidioidal infection during
pregnancy, their management depends on fetal maturity.
