Approach to the Critical Patient

Immediate priorities

Airway and respiratory threats

Monitoring and targets

Monitoring bundle

Escalation triggers

Immediate consults

Consultation triggers

History

Presentation pattern

Core symptoms

Exposure and travel history

Geographic exposure

Risk factors for dissemination

Immunosuppressive conditions

Demographic risk factors

Symptom characterization

Extrapulmonary site symptoms

Physical Exam

Vitals and general

Hemodynamic and respiratory stability

Skin exam

Cutaneous findings

Neurologic exam

Meningitis signs

Musculoskeletal exam

Skeletal and joint assessment

Pulmonary and lymphatic exam

Chest findings

Differential Diagnosis

Infectious mimics

Other endemic mycoses

Mycobacterial infection

Pulmonary mimics

Pneumocystis jirovecii pneumonia (ICD-10 B59)

Bacterial community-acquired pneumonia (ICD-10 J18)

Meningitis mimics

Bacterial meningitis (ICD-10 G00)

Viral meningitis (ICD-10 A87)

Sarcoidosis (ICD-10 D86)

Laboratory Tests

Serologic testing

Coccidioidal serology

Antigen detection

Coccidioidal antigen testing

CSF analysis

Lumbar puncture findings in coccidioidal meningitis

Hematology and chemistry

Complete blood count

Metabolic panel

Microbiologic cultures

Tissue and fluid cultures

Diagnostic Tests

Scoring Systems

Severity classification framework

MRI

MRI brain with gadolinium contrast

MRI spine and skeletal

CT

CT chest

CT of affected extrapulmonary sites

CT head without contrast

Ultrasound

Focused bedside ultrasound

Disposition

Admission indications

Inpatient admission criteria

ICU criteria

ICU admission triggers

Transfer criteria

Transfer indications

Discharge criteria

Criteria for safe discharge

Treatment

Antifungal therapy — mild non-CNS disseminated disease

Fluconazole first-line

Antifungal therapy — severe disseminated non-CNS disease

Lipid amphotericin B induction

Antifungal therapy — coccidioidal meningitis

Fluconazole high-dose — mainstay of meningitis treatment

Intrathecal amphotericin B for refractory meningitis

Hydrocephalus management

VP shunt placement

Salvage and refractory disease

Alternative triazoles for refractory disease

Adjunctive immunotherapy

Supportive care

Nephroprotection during amphotericin B

QT monitoring on azole therapy

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Age-related considerations

Pediatrics

Pediatric-specific features

Background

Epidemiology

Incidence and prevalence

Pathophysiology

Organism and infection cycle

Therapeutic Considerations

Antifungal pharmacology

Treatment duration principles

Echinocandin limitation

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for Coccidioidomycosis (Disseminated)

References

Guidelines and key sources

Primary guidelines

Key evidence

Landmark studies and reviews

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.