137: Cocci Me If You Can

Coccidioidomycosis, or Valley Fever, remains a significant diagnostic challenge due to its ability to mimic common bacterial or viral pneumonias. In endemic regions like Tucson, Arizona, clinicians must prioritize testing for the fungus in patients with persistent respiratory symptoms, as early identification significantly improves outcomes. Disseminated disease, especially coccidioidal meningitis, necessitates lifelong antifungal therapy and often requires permanent ventricular-peritoneal shunting to manage hydrocephalus. Lumbar puncture serves as the gold standard for diagnosis, as ventricular fluid samples often fail to capture the full severity of basilar inflammation. While current treatments rely on azoles and amphotericin B, emerging therapies like Olorofim and experimental vaccines targeting the Delta CPS1 strain show promise in reducing the disease's substantial physiological and economic burden. Clinicians should maintain a high index of suspicion, particularly when evaluating patients with travel history to endemic areas.