Certain persons are unable to localize coccidioidal infection. Dissemination, which is rare and occurs mainly in males, especially Filipinos, other Asians, and blacks, usually follows the initial illness within 6mo, often without any interlude. This is analogous to the course of progressive primary tuberculosis. Persons with blood group B may be particularly disposed to dissemination. Certain immunosuppressed states enhance dissemination or bring about relapse of apparently arrested coccidioidomycosis.
Dissemination is enhanced if coccidioidal infection is acquired during pregnancy.
Skin lesions and cold abscesses, both subcutaneous and osseous, occur. Meningitis is the most serious of the disseminated lesions and is clinically similar to tuberculous meningitis. In whites it is not unusual for meningitis to be the only extrapulmonary lesion. Miliary dissemination and peritonitis may be distinguishable from tuberculosis only by demonstration of the causative agent, though coccidioidal peritonitis may present as a very mild disease. Diagnosis of the disseminated infection may be established by biopsy or at autopsy.