247.3 📌 章末速蚘

  • Valley Fever: Coccidioides spp. (immitis + posadasii)
  • SW USA + Northern Mexico + Latin America endemic
  • Spherules with endospores = pathognomonic
  • Acute: flu-like + erythema nodosum + arthralgia (“desert rheumatism”) + eosinophilia
  • Dissemination risk: Filipino + African American + pregnancy + immunocompromise
  • Treatment: most asymptomatic / mild — observation; severe / disseminated — fluconazole; CNS = lifelong fluconazole
  • Pregnancy: AmB (avoid azoles)
  • BSL-3 lab (highly infectious cultures)
  • 2024 climate change: range expanding
247.3.0.0.1 盧醫垫 hint
  • SW USA returnee + flu-like + erythema nodosum + arthralgia → Valley Fever
  • HIV + endemic area + skin / bone lesion → disseminated coccidioidomycosis
  • Pregnant + endemic + symptoms → AmB