247.2 📚 國考版

247.2.0.1 必背 — Pathogen + Geography

  • C. immitis (California) + C. posadasii (other SW USA, Latin America)
  • SW USA endemic (Arizona, California, Nevada, NM, west TX, UT)
  • Northern Mexico + Central + South America
  • Soil + arid; dust storms + construction → outbreaks

247.2.0.2 必背 — Microbiology

  • Dimorphic
  • Spherules with endospores on histology — pathognomonic
  • BSL-3 (highly infectious cultures)

247.2.0.3 必背 — Acute “Valley Fever”

  • Flu-like + erythema nodosum + erythema multiforme + arthralgia (“desert rheumatism”) + eosinophilia
  • Self-limited weeks
  • Pulmonary infiltrates / nodules

247.2.0.4 必背 — Dissemination Risk Factors

  • Filipino (highest)
  • African American
  • Pregnancy (3rd trimester + postpartum)
  • HIV CD4 < 250
  • Solid organ + HSCT
  • DM
  • Hispanic + Native American (intermediate)

247.2.0.5 必背 — Coccidioidal Meningitis

  • Lifelong fluconazole treatment (otherwise relapse)
  • VP shunt for hydrocephalus
  • High morbidity / mortality

247.2.0.6 必背 — Treatment

Form Drug Duration
Asymptomatic None —
Mild acute Often no treatment —
Severe acute / chronic Fluconazole 400-800 mg/d 6-12 mo+
Disseminated Fluconazole 400-800 mg/d Lifelong often
CNS Fluconazole lifelong Lifelong
Severe / multi-organ AmB induction → fluconazole Long
Pregnancy AmB (avoid azoles) Variable

247.2.0.7 必背 — Diagnosis

  • Serology (CF, immunodiffusion)
  • Histology: spherules with endospores
  • Culture (BSL-3)
  • PCR emerging