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Late Progression of Pulmonary Coccidioidomycosis

MAURICE J. SMALL, M.D.
AMA Arch Intern Med. 1959;104(5):730-740. doi:10.1001/archinte.1959.00270110050006.
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It is generally thought that the fungus, Coccidioides immitis, produces the following clinical course:

... a primary and a disseminated form of the disease, the former being a benign infection and the latter a serious disease.... Probably not more than 1% of patients... develop disseminating coccidioidomycosis, following failure of the initial infection to focalize. Dissemination is a continuation of the primary infection and due to endogenous reinfection. There is no actual interval or recession of the disease process between the primary and disseminating phases of the infection.... Dissemination of the infection is unusual and catastrophic.... Other gross lesions associated with the development of the initial disease process include primary cavitation, usually in association with acute pneumonitis. These cavities are transient and tend to close spontaneously. They are to be differentiated from the residual pulmonary cavity, which appears later on roentgenogram as a thin-walled cyst-like structure with little or no evidence of

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