The Rise of Coccidioides: Forces Against the Dust Devil Unleashed

Abstract

Coccidioidomycosis (Valley fever) is a fungal disease caused by the inhalation of Coccidioides posadasii or C. immitis. This neglected disease occurs in the desert areas of the western United States, most notably in California and Arizona, where infections continue to rise. Clinically, coccidioidomycosis ranges from asymptomatic to severe pulmonary disease and can disseminate to the brain, skin, bones, and elsewhere. New estimates suggest as many as 350,000 new cases of coccidioidomycosis occur in the United States each year. Thus, there is an urgent need for the development of a vaccine and new therapeutic drugs against Coccidioides infection. In this review, we discuss the battle against Coccidioides including the development of potential vaccines, the quest for new therapeutic drugs, and our current understanding of the protective host immune response to Coccidioides infection.

Keywords: Coccidioides; antifungal drugs; fungal vaccines; immunity; valley fever.

Figure 1

Potential Organs Infected by Coccidioides. Since inhalation is the most common route of infection, the lungs are the most common organ that becomes infected with Coccidioides; however, dissemination can occur allowing for multiple organs, highlighted above, to become infected but are uncommon (Illustration created with BioRender).

Figure 2

Three Arsenals to Combat Coccidioides. Here we highlight the current battle against Coccidioides from antifungals, potential vaccines, and the protective host immune response. Bolded terms: important for host protection, most common antifungal drug, and most promising current vaccine candidates against coccidioidomycosis. Color coding for antifungal drug classes: purple, Azoles; blue, drugs in development; and orange, Polyenes (Illustration created with BioRender).