Diseases and conditions that alter immune responses also predispose to dissemination and serious disease. Those at special risk for disseminated, extrapulmonary coccidioidomycosis are pregnant women. Filipinos have the highest risk of dissemination, about 10-175 times the risk of whites. Blacks and Hispanics also have a higher risk of dissemination than whites. Mortality rate is 5 times greater for blacks than for whites.
Incidence is equal in males and females.
Congenital infection is rarely a factor in childhood coccidioidomycosis. In disseminated disease, the mortality rates in neonates and infants are much higher than those in children, adolescents, and adults. Cough is nonproductive and often is accompanied by fever, night sweats, headache, pleuritic chest pain, malaise, and myalgias. Although these are very nonspecific symptoms, a level of suspicion should be maintained for those who live in or have traveled to endemic areas or have persistent symptoms. Consider coccidioidomycosis in those at risk who develop a constellation of nonspecific signs or unusual rashes, such as erythema nodosum, erythema multiforme or toxic erythema, or arthralgias.