Complement-fixing antibody is more frequently detected in cisternal and lumbar fluid but may be deceptively absent from the ventricular fluid. During the primary infection roentgenograms of the chest may not reveal pulmonary changes. Hilar lymphadenopathy is frequent, and there may be single or multiple, sharply circumscribed or soft, feathery, small pulmonary densities or larger consolidated areas. Acute respiratory insufficiency may result. Pulmonary cavities, which occur less frequently in children than in adults, tend to be thin-walled when present.
Pleural effusions vary in extent.
Osseous lesions, which are usually multiple and have a predilection for cancellous bone, often are widespread and are generally indistinguishable from those of tuberculosis. With the advent of the relatively benign oral azoles, physicians have often initiated therapy as soon as coccidioidomycosis is suspected or confirmed. Indications for the choice of medications are not clearly defined. Once the full dose has been achieved, it can be given every other day or two to three times a week to minimize renal toxicity. Amphotericin B does not cross the blood-brain barrier in therapeutic amounts for C. immitis , but it may mask the presence of meningitis.