When the spherules dehisce, an endospore may mature as quickly as 48-72 hours into another spherule. Although cocci are not contagious, lab personnel handling specimens from cocci patients must follow class III precautions carefully to avoid contracting the illness. A pyogenic, eventually granulomatous, respiratory infection ensues. Caseation without calcification may occur. Respiratory infection usually is endobrochiolitis.
Hilar adenopathy is common.
Some develop intrapulmonary complications, such as tissue necrosis, abscesses, and cavitary lesions. Persistent pulmonary disease may manifest as persistent bronchitis and pneumonia or variable progression to late disease, including cavitation and abscesses. A subset of patients at risk will develop extrapulmonary infection. The infection spreads hematogenously either during the primary infection or as a reactivation from a chronic pulmonary focus. Extrapulmonary disease is caused by dissemination and may involve hematopoietic tissues, skin, kidneys, bones, CNS, and myocardium.