Ninety five percent of acute episodes resolved spontaneously. Nevertheless, follow up for 1 to 2 years is recomended for early identification of chronic pulmonary and extrapulmonary forms. Ketoconazole, fluconazole and itraconazole have all been used. Length of therapy should be at least 1 year. The tissue reaction is one of acute suppurative and granulomatous inflammation.
Acute suppuration is usually present around the arthroconidia and after a spherule ruptures.
Granulomatous inflammation usually occurs around developing spherules. Endospores are released when the wall of the spherule ruptures. Endospores that are no longer in a spherule may remain close to each other, resulting in a potential confusion with the yeast cells of Blastomyces dermatitidis . This is especially true if the spherule wall is no longer visible and the clinical specimen has been homogenized. Coccidioides immitis is a dangerous fungus and should be handled at all times with due respect in a Class II or III biological safety cabinet.