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Coccidioides immitis and C. posadasii are etiologic agents of coccidioidomycosis. Major endemic zones are arid and semi-arid climates in North America, such as the northern Mexican states and the southwestern United States. Coccidioides spp. is a dimorphic fungus that forms arthroconidia during its mycelial phase while growing in soil. Coccidioides spp. enters the lungs through airways and causes an infection and the inhalation of arthroconidia by a susceptible host, initiates the parasitic phase. The infection is usually benign, however, the infection is sometimes severe and lethal, particularly in immunocompromised patients. Elderly persons are at greater risk of developing severe pulmonary disease, while disseminated infection is more frequent in black patients and pregnant women. Transplant patients on immunosuppressive therapy or with human immunodeficiency virus infection have a higher risk of developing severe and progressive coccidioidomycosis. In the host the arthroconidia is transformed into endospore-containing spherules, which are classically found in Coccidioides spp. infected tissue. Although parasitic mycelial structures have been identified in some cases, these non classic mycelial structures of Coccidioides spp. have not been observed in human tissue or fluid, but when fungal structures are examined, hyphae can be found in up to 50% of specimens. Parasitic mycelial forms have been observed mainly in specimens from lung tissue, sputum, cerebrospinal fluid, and nervous tissue. Parasitic mycelial forms of Coccidioides spp. are less frequently observed in pleural fluid, and gastric lavage product. Pulmonary coccidioidomycosis shares clinical manifestations with other pulmonary pathologies, including other mycoses, neoplasia, and tuberculosis. Diagnosis of pulmonary coccidioidomycosis is a multidisciplinary effort.

Innovation of the Parasitic Cycle of Coccidioides spp.