Which symptom cluster is typical of coccidioidomycosis in an otherwise healthy adult?

Which symptom cluster is typical of coccidioidomycosis in an otherwise healthy adult?

• A. Pneumonia with rusty sputum
• B. Flu-like syndrome with fever, night sweats, dry cough, weight loss, and myalgia
• C. Chronic productive cough with hemoptysis
• D. Acute meningitis without respiratory symptoms

Answer: (B)

Coccidioidomycosis (valley fever) in an otherwise healthy adult most commonly presents as a flu-like illness after inhaling the fungal spores. The characteristic symptom cluster includes fever, night sweats, a dry cough, weight loss, and myalgias. This pattern reflects the body’s short, self-limited inflammatory response to the inhaled organism, and many cases resolve without specific antifungal therapy. In some people, especially young adults, erythema nodosum or arthralgias (desert rheumatism) can accompany the systemic symptoms, which helps clue you in to this infection in endemic areas. Other presentations described in the choices align with different conditions: pneumonia with rusty sputum suggests pneumococcal pneumonia; a chronic productive cough with hemoptysis raises concern for chronic bacterial infection, TB, or bronchiectasis; acute meningitis without respiratory symptoms points away from a primary pulmonary coccidioidomycosis and toward other causes of meningitis, with coccidioidal meningitis usually part of disseminated disease and often with subacute or chronic CNS symptoms. In healthy adults, the flu-like syndrome is the most typical entry presentation for coccidioidomycosis.

Coccidioidomycosis (valley fever) in an otherwise healthy adult most commonly presents as a flu-like illness after inhaling the fungal spores. The characteristic symptom cluster includes fever, night sweats, a dry cough, weight loss, and myalgias. This pattern reflects the body’s short, self-limited inflammatory response to the inhaled organism, and many cases resolve without specific antifungal therapy. In some people, especially young adults, erythema nodosum or arthralgias (desert rheumatism) can accompany the systemic symptoms, which helps clue you in to this infection in endemic areas.

Other presentations described in the choices align with different conditions: pneumonia with rusty sputum suggests pneumococcal pneumonia; a chronic productive cough with hemoptysis raises concern for chronic bacterial infection, TB, or bronchiectasis; acute meningitis without respiratory symptoms points away from a primary pulmonary coccidioidomycosis and toward other causes of meningitis, with coccidioidal meningitis usually part of disseminated disease and often with subacute or chronic CNS symptoms. In healthy adults, the flu-like syndrome is the most typical entry presentation for coccidioidomycosis.