Coccidioidomycosis in Immunocompromised at a Non-Endemic Referral Center in Mexico.

The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.

Evaluation of the Analytical Performance of a Lateral Flow Assay for the Detection of Anti-Coccidioides Antibodies in Human Sera-Argentina.

Coccidiomycosis is a potentially life-threatening fungal infection endemic to certain regions of Argentina. The infection is caused by Coccidioides spp. and is primarily diagnosed by Coccidioides antibody (Ab) detection. Access to rapid, highly accurate diagnostic testing is critical to ensure prompt antifungal therapy. The sona Coccidioides Ab Lateral Flow Assay (LFA) performs faster and requires less laboratory infrastructure and equipment compared with other Ab detection assays, potentially providing a substantial improvement for rapid case screening in coccidioidomycosis-endemic regions; however, validation of this test is needed. Thus, we aimed to evaluate the analytical performance of the sona Coccidioides Ab (LFA) and compare agreement with anti-Coccidioides Ab detection assays. A total of 103 human sera specimens were tested, including 25 specimens from patients with coccidioidomycosis and 78 from patients without coccidioidomycosis. The sona Coccidioides Ab Lateral Flow Assay (LFA) was performed with a sensitivity of 88%, and specificity and accuracy of 87%. Furthermore, the Coccidioides Ab LFA had good agreement with other anti-Coccidioides Ab detection assays. Our findings suggest the sona Coccidioides Ab LFA has satisfactory performance and may be useful for diagnosing coccidioidomycosis in endemic regions.

Epidemiology of coccidioidomycosis in Argentina, an update.

The National Reference Laboratory in Clinical Mycology of Argentina conducted a retrospective review of human coccidioidomycosis cases diagnosed by the National Mycology Laboratory Network of Argentina between 2010 and 2022 to determine the burden of the disease in the country. A total of 100 human coccidioidomycosis cases were documented, with a higher prevalence in male patients (male-to-female ratio of 1.9:1), with a median age of 41 years. Comparing the number of cases between two 10-year periods (2000-2009 and 2010-2019), the increase was 36.51% (from 63 to 86 cases). Among the 100 recorded cases, 79 tested positive using the double immunodiffusion test. Spherules were observed in 19 cases through histopathology or direct microscopic examination and the fungus was isolated in 39 cases. Thirty-six isolates were identified as Coccidioides posadasii through partial sequencing of the Ag2/PRA gene. Catamarca province had the highest number of cases, comprising 64% of the total, with an incidence rate above 1.0-2.5/100,000 inhabitants until 2018. However, there has been a recent downward trend in the region from 2018 to 2022. It is concerning that more than half of diagnosed cases were chronic pulmonary or disseminated forms, indicating a lack of early disease detection. To rectify this issue, it is imperative to conduct targeted training programs for healthcare personnel and enhance public awareness within the endemic area. This will contribute to a better understanding of the true burden of coccidioidomycosis and enable the implementation of appropriate sanitary control measures.

Periampullary Mass as an Unusual Manifestation of Coccidioidomycosis. Case Report and Literature Review

In Colombia, coccidioidomycosis is a rare entity, and the intestinal manifestation is infrequent, with around a dozen cases reported in the world literature. This article reports the case of a 29-year-old male Venezuelan immigrant with a 4-month history of abdominal pain, jaundice, nausea, and vomiting. The tomography and the endoscopic study revealed a circumferential exophytic mass in the second portion of the duodenum. The biopsy revealed multiple spherules filled with round fungal endospores with a final diagnosis of disseminated coccidioidomycosis. The patient was discharged before the final pathology report with fluconazole doses of 200 mg every other day and an order for outpatient magnetic resonance cholangiography for outpatient follow-up, which he has not attended.

La coccidioidomicosis en Colombia es una entidad infrecuente y la presentación intestinal es extremadamente rara, con alrededor de una docena de casos reportados en la literatura mundial. En el presente artículo se reporta el caso de un paciente inmigrante venezolano masculino de 29 años con historia de dolor abdominal, ictericia, náuseas y vómito de 4 meses de evolución. La tomografía y el estudio endoscópico evidenciaron una masa exofítica circunferencial en la segunda porción del duodeno. La biopsia reveló múltiples esférulas llenas de endosporas fúngicas redondas con diagnóstico final de coccidioidomicosis diseminada. El paciente fue dado de alta antes del reporte final anatomopatológico con dosis de fluconazol de 200 mg interdiario y orden de colangiorresonancia ambulatoria para control ambulatorio, mismo al cual no ha asistido.

Modeling Chronic Coccidioidomycosis in Mice.

Coccidioidomycosis, caused by the dimorphic pathogens Coccidioides posadasii and C. immitis, is a fungal disease endemic to the southwestern United States, Mexico, and some regions of Central and South America. The mouse is the primary model for studying pathology and immunology of disease. Mice in general are extremely susceptible to Coccidioides spp., which creates challenges in studying the adaptive immune responses that are required for host control of coccidioidomycosis. Here, we describe how to infect mice to model asymptomatic infection with controlled, chronic granulomas and a slowly progressive but ultimately fatal infection that has kinetics more similar to the human disease.

Coccidioidomycosis Osteomyelitis of Distal Tibia in a Preschool Girl: A Case Report.

Introduction: Coccidioides immitis is a fungus that develops in endemic areas characterized by dry climates, with little rainfall and easy aerial dissemination. The most common form of infection is pulmonary coccidioidomycosis, although it is often asymptomatic. There are non-respiratory forms of this disease. Osteomyelitis is an extrapulmonary manifestation of C. immitis infection. Symptoms are usually nonspecific and radiographic findings are often confused with bone tumors. Treatment of coccidioidal osteomyelitis is often challenging. Case Presentation: We report a case of a 3-year-old preschool girl from an endemic area for coccidioidomycosis who presented with pain and swelling on her left ankle. Initially, antibiotic treatment is administered for a suspected insect bite. However, her symptoms worsened and X-rays showed a lytic-like lesión. She was admitted to the hospital for biopsy and drainage surgery. The histopathological study confirms coccidioidomycosis osteomyelitis. She was started on long-term anti-fungal treatment. At 6-month follow-up, symptoms and signs of infection have been solved and X-ray image shows evidence of bone healing. Conclusion: It is important to take into account aspects related to exposure to this fungus, such as the patient's place of residence and recent trips so that the diagnostic and therapeutic approach is appropriate. Coccidioidal osteomyelitis is an infrequent pathology, especially in patients without other comorbidities. Treatment is complex and often requires not only antifungal drugs but also surgical debridement.

The clinical laboratory evolution in coccidioidomycosis detection: Future perspectives.

Coccidioidomycosis is a systemic disease caused by the fungi Coccidioides immitis and C. posadasii. It is a prevalent disease in arid regions with high temperatures and low precipitations in America. Coccidioidomycosis is a highly endemic disease of US-Mexico border states but commonly underdiagnosed. The diagnosis of coccidiomycosis is not easy due to the lack of specific symptoms; it is usually an integral approach, including clinical laboratory tests as an essential part of the diagnosis. Nevertheless, despite various laboratory tests available, affordability can be a limitation, mainly in developing countries. This review's objectives are 1) to learn the different laboratory approaches that arose and their application for clinical diagnosis; 2) to discuss their advantages and weaknesses, and finally, 3) propose what is on the horizon for future advances in clinical laboratory diagnosis of coccidioidomycosis. It has been a long way in laboratory tests evolution to detect coccidioidomycosis from tissue microscopy to Real-Time PCR. However, there is a delay in technology adoption for Coccidioides spp. detection in the clinical laboratory. The molecular Point of Care Testing (POCT) technology has reached us in our trench while research in PCR variants stills on-going. None of the currently existing scientific literature in coccidioidomycosis research has mentioned it. However, this trend in infectious and non-infectious disease diagnosis will continue in that way in order to offer better options for an easy and fast diagnosis. Undoubtedly, the implementation of molecular POCT for Coccidioides spp. would save resources in health care attention and improve access to diagnostic tools.

Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease.

Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.

Systemic coccidioidomycosis in a dog in Northeastern Brazil / Coccidioidomicose sistêmica em um cão no Nordeste do Brasil

We described a case of systemic infection by Coccidioides sp. in a dog. An adult, mixed breed, free-ranging male dog presented with clinical signs that included apathy, cachexia, anorexia, limited mobility with sternal recumbency, bilateral mucopurulent ocular discharge, dyspnoea, pulmonary crepitation, erosive and nodular lesions on the skin, and swelling and stiffness of the left tibiotarsal joint. The dog was submitted to a postmortem examination. Grossly, there were multiple yellow to white nodules in various organs. Histologically, the lesions were characterized as pyogranulomatous inflammation associated with fungal spherules morphologically consistent with Coccidioides sp. The dog was concomitantly diagnosed with undifferentiated sarcoma affecting the skin, lymph nodes, liver, and testicles. The diagnosis of coccidioidomycosis was made based on the histologic changes associated with morphotintorial features and positive immunolabeling of organisms with anti-Coccidioides immunohistochemistry. This case demonstrated that Coccidioides sp. can infect dogs that inhabit urban centers in the semiarid region of Northeastern Brazil, likely due to exposure to dust from contaminated environments.

Descreve-se um caso de infecção sistêmica por Coccidioides em um cão. Um cão adulto, sem raça definida e errante, atendido com sinais clínicos que incluíram apatia, caquexia, anorexia, dificuldade de locomoção com decúbito esternal, secreção ocular bilateral mucopurulenta, dispneia, crepitação pulmonar, lesões erosivas e nodulares na pele, aumento de volume e rigidez na articulação tibiotársica do membro pélvico esquerdo. O cão foi submetido a um exame post-mortem. Macroscopicamente, haviam múltiplos nódulos amarelo-brancacentos em vários órgãos. Histologicamente, as lesões foram caracterizadas por inflamação piogranulomatosa associada a esférulas fúngicas morfologicamente consistentes com Coccidioides sp. O cão foi diagnosticado concomitantemente com sarcoma indiferenciado afetando a pele, linfonodos, fígado e testículos. O diagnóstico de coccidioidomicose foi realizado com base nas alterações histológicas associadas as características morfotintoriais e imunomarcação positiva dos organismos com anti-Coccidioides na imuno-histoquímica. Esse caso demonstra que Coccidioides sp. pode infectar cães que habitam centros urbanos no semiárido do Nordeste do Brasil, provavelmente devido à exposição a poeira de ambientes contaminados.

Systemic coccidioidomycosis in a dog in Northeastern Brazil / Coccidioidomicose sistêmica em um cão no Nordeste do Brasil

We described a case of systemic infection by Coccidioides sp. in a dog. An adult, mixed breed, free-ranging male dog presented with clinical signs that included apathy, cachexia, anorexia, limited mobility with sternal recumbency, bilateral mucopurulent ocular discharge, dyspnoea, pulmonary crepitation, erosive and nodular lesions on the skin, and swelling and stiffness of the left tibiotarsal joint. The dog was submitted to a postmortem examination. Grossly, there were multiple yellow to white nodules in various organs. Histologically, the lesions were characterized as pyogranulomatous inflammation associated with fungal spherules morphologically consistent with Coccidioides sp. The dog was concomitantly diagnosed with undifferentiated sarcoma affecting the skin, lymph nodes, liver, and testicles. The diagnosis of coccidioidomycosis was made based on the histologic changes associated with morphotintorial features and positive immunolabeling of organisms with anti-Coccidioides immunohistochemistry. This case demonstrated that Coccidioides sp. can infect dogs that inhabit urban centers in the semiarid region of Northeastern Brazil, likely due to exposure to dust from contaminated environments.(AU)

Descreve-se um caso de infecção sistêmica por Coccidioides em um cão. Um cão adulto, sem raça definida e errante, atendido com sinais clínicos que incluíram apatia, caquexia, anorexia, dificuldade de locomoção com decúbito esternal, secreção ocular bilateral mucopurulenta, dispneia, crepitação pulmonar, lesões erosivas e nodulares na pele, aumento de volume e rigidez na articulação tibiotársica do membro pélvico esquerdo. O cão foi submetido a um exame post-mortem. Macroscopicamente, haviam múltiplos nódulos amarelo-brancacentos em vários órgãos. Histologicamente, as lesões foram caracterizadas por inflamação piogranulomatosa associada a esférulas fúngicas morfologicamente consistentes com Coccidioides sp. O cão foi diagnosticado concomitantemente com sarcoma indiferenciado afetando a pele, linfonodos, fígado e testículos. O diagnóstico de coccidioidomicose foi realizado com base nas alterações histológicas associadas as características morfotintoriais e imunomarcação positiva dos organismos com anti-Coccidioides na imuno-histoquímica. Esse caso demonstra que Coccidioides sp. pode infectar cães que habitam centros urbanos no semiárido do Nordeste do Brasil, provavelmente devido à exposição a poeira de ambientes contaminados.(AU)

Systemic coccidioidomycosis in a dog in Northeastern Brazil / Coccidioidomicose sistêmica em um cão no Nordeste do Brasil

ABSTRACT: We described a case of systemic infection by Coccidioides sp. in a dog. An adult, mixed breed, free-ranging male dog presented with clinical signs that included apathy, cachexia, anorexia, limited mobility with sternal recumbency, bilateral mucopurulent ocular discharge, dyspnoea, pulmonary crepitation, erosive and nodular lesions on the skin, and swelling and stiffness of the left tibiotarsal joint. The dog was submitted to a postmortem examination. Grossly, there were multiple yellow to white nodules in various organs. Histologically, the lesions were characterized as pyogranulomatous inflammation associated with fungal spherules morphologically consistent with Coccidioides sp. The dog was concomitantly diagnosed with undifferentiated sarcoma affecting the skin, lymph nodes, liver, and testicles. The diagnosis of coccidioidomycosis was made based on the histologic changes associated with morphotintorial features and positive immunolabeling of organisms with anti-Coccidioides immunohistochemistry. This case demonstrated that Coccidioides sp. can infect dogs that inhabit urban centers in the semiarid region of Northeastern Brazil, likely due to exposure to dust from contaminated environments.

RESUMO: Descreve-se um caso de infecção sistêmica por Coccidioides em um cão. Um cão adulto, sem raça definida e errante, atendido com sinais clínicos que incluíram apatia, caquexia, anorexia, dificuldade de locomoção com decúbito esternal, secreção ocular bilateral mucopurulenta, dispneia, crepitação pulmonar, lesões erosivas e nodulares na pele, aumento de volume e rigidez na articulação tibiotársica do membro pélvico esquerdo. O cão foi submetido a um exame post-mortem. Macroscopicamente, haviam múltiplos nódulos amarelo-brancacentos em vários órgãos. Histologicamente, as lesões foram caracterizadas por inflamação piogranulomatosa associada a esférulas fúngicas morfologicamente consistentes com Coccidioides sp. O cão foi diagnosticado concomitantemente com sarcoma indiferenciado afetando a pele, linfonodos, fígado e testículos. O diagnóstico de coccidioidomicose foi realizado com base nas alterações histológicas associadas as características morfotintoriais e imunomarcação positiva dos organismos com anti-Coccidioides na imuno-histoquímica. Esse caso demonstra que Coccidioides sp. pode infectar cães que habitam centros urbanos no semiárido do Nordeste do Brasil, provavelmente devido à exposição a poeira de ambientes contaminados.

Of Mice and Fungi: Coccidioides spp. Distribution Models.

The continuous increase of Coccidioidomycosis cases requires reliable detection methods of the causal agent, Coccidioides spp., in its natural environment. This has proven challenging because of our limited knowledge on the distribution of this soil-dwelling fungus. Knowing the pathogen's geographic distribution and its relationship with the environment is crucial to identify potential areas of risk and to prevent disease outbreaks. The maximum entropy (Maxent) algorithm, Geographic Information System (GIS) and bioclimatic variables were combined to obtain current and future potential distribution models (DMs) of Coccidioides and its putative rodent reservoirs for Arizona, California and Baja California. We revealed that Coccidioides DMs constructed with presence records from one state are not well suited to predict distribution in another state, supporting the existence of distinct phylogeographic populations of Coccidioides. A great correlation between Coccidioides DMs and United States counties with high Coccidioidomycosis incidence was found. Remarkably, under future scenarios of climate change and high concentration of greenhouse gases, the probability of habitat suitability for Coccidioides increased. Overlap analysis between the DMs of rodents and Coccidioides, identified Neotoma lepida as one of the predominant co-occurring species in all three states. Considering rodents DMs would allow to implement better surveillance programs to monitor disease spread.

Advances in Fungal Peptide Vaccines.

Vaccination is one of the greatest public health achievements in the past century, protecting and improving the quality of life of the population worldwide. However, a safe and effective vaccine for therapeutic or prophylactic treatment of fungal infections is not yet available. The lack of a vaccine for fungi is a problem of increasing importance as the incidence of diverse species, including Paracoccidioides, Aspergillus, Candida, Sporothrix, and Coccidioides, has increased in recent decades and new drug-resistant pathogenic fungi are emerging. In fact, our antifungal armamentarium too frequently fails to effectively control or cure mycoses, leading to high rates of mortality and morbidity. With this in mind, many groups are working towards identifying effective and safe vaccines for fungal pathogens, with a particular focus of generating vaccines that will work in individuals with compromised immunity who bear the major burden of infections from these microbes. In this review, we detail advances in the development of vaccines for pathogenic fungi, and highlight new methodologies using immunoproteomic techniques and bioinformatic tools that have led to new vaccine formulations, like peptide-based vaccines.

Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018.

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

The Role of the Interleukin-17 Axis and Neutrophils in the Pathogenesis of Endemic and Systemic Mycoses.

Systemic and endemic mycoses are considered life-threatening respiratory diseases which are caused by a group of dimorphic fungal pathogens belonging to the genera Histoplasma, Coccidioides, Blastomyces, Paracoccidioides, Talaromyces, and the newly described pathogen Emergomyces. T-cell mediated immunity, mainly T helper (Th)1 and Th17 responses, are essential for protection against these dimorphic fungi; thus, IL-17 production is associated with neutrophil and macrophage recruitment at the site of infection accompanied by chemokines and proinflammatory cytokines production, a mechanism that is mediated by some pattern recognition receptors (PRRs), including Dectin-1, Dectine-2, TLRs, Mannose receptor (MR), Galectin-3 and NLPR3, and the adaptor molecules caspase adaptor recruitment domain family member 9 (Card9), and myeloid differentiation factor 88 (MyD88). However, these PRRs play distinctly different roles for each pathogen. Furthermore, neutrophils have been confirmed as a source of IL-17, and different neutrophil subsets and neutrophil extracellular traps (NETs) have also been described as participating in the inflammatory process in these fungal infections. However, both the Th17/IL-17 axis and neutrophils appear to play different roles, being beneficial mediating fungal controls or detrimental promoting disease pathologies depending on the fungal agent. This review will focus on highlighting the role of the IL-17 axis and neutrophils in the main endemic and systemic mycoses: histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis.

Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

Abstract INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

Population Structure and Genetic Diversity among Isolates of Coccidioides posadasii in Venezuela and Surrounding Regions.

Coccidioides posadasii is a pathogenic fungus that causes coccidioidomycosis in many arid regions of the Americas. One of these regions is bordered by the Caribbean Sea, and the surrounding landscape may play an important role in the dispersion of C. posadasii across South America through southeastern Mexico, Honduras, Guatemala, and Venezuela. Comparative phylogenomic analyses of C. posadasii reveal that clinical strains from Venezuela are genetically distinct from the North American populations found in (i) Arizona and (ii) Texas, Mexico, and the rest of South America (TX/MX/SA). We find evidence for admixture between the Venezuela and the North American populations of C. posadasii in Central America. Additionally, the proportion of Venezuelan alleles in the admixed population decreases as latitude (and distance from Venezuela) increases. Our results indicate that the population in Venezuela may have been subjected to a recent bottleneck and shows a strong population structure. This analysis provides insight into potential for Coccidioides spp. to invade new regions.IMPORTANCE Valley Fever is a fungal disease caused by two species of fungi: Coccidioides immitis and C. posadasii These fungi are found throughout the arid regions of North and South America; however, our understanding of genetic diversity and disease in South America is limited. In this report, we analyze 10 new genomes of Coccidioides posadasii from regions bordering the Caribbean Sea. We show that these populations are distinct and that isolates from Venezuela are likely a result of a recent bottleneck. These data point to patterns that might be observed when investigating recently established populations.

Design and evaluation of an AFLP molecular marker for the detection of Coccidioides spp. in biological samples.

At present, there is no standardized marker that is routinely used in clinical laboratories to diagnose coccidioidomycosis. Thus, the goals of this study were to obtain a sequence characterized amplified region (SCAR) marker for the identification of Coccidioides spp., evaluate its specificity and sensitivity in fungal DNA-spiked blood and sputum samples, and compare it with previously described molecular markers. Specific amplified fragment length polymorphism (AFLP) amplicons for Coccidioides immitis and Coccidioides posadasii were cloned into the vector pGEM® -T Easy vector and sequenced to develop a SCAR marker. Oligonucleotides were designed to identify Coccidioides spp. by polymerase chain reaction (PCR), and the specificity and sensitivity of these oligonucleotides were tested with the DNA from related pathogens. The specificity and sensitivity of the SCAR marker was evaluated with blood and sputum samples spiked with Coccidioides DNA and compared with other previously described markers (621, GAC2, and Ag2/PRA). In addition, the conditions for its use were established using biological samples. A specific marker named SCAR300 was obtained to identify Coccidioides spp. that exhibited good sensitivity and specificity. The results showed that all of the markers tested in this study can identify Coccidioides spp. However, the SCAR300 and 621 markers were the most sensitive, whereas the SCAR300 marker was the most specific. Thus, the SCAR300 marker is a useful tool to identify Coccidioides spp.