The incidence and implications of coccidioidouria

To estimate the frequency and significance of isolating Coccidioides immitis from urine specimens, we reviewed the records of 75 patients with various forms of coccidioidomycosis of whom 29 had urine cultures for the fungi. The 7 patients (24%) who had coccidioidouria appeared similar as a group to those whose cultured urine did not yield C. immitis. Over half of the patients had no other evidence of extrathoracic spread, and in 2 patients with coccidioidouria, illness resolved without treatment. Usually only a few colonies of the fungus were isolated from 200-ml specimens. Thus, our use of a concentrating technique and repeated sampling may account for the high incidence of coccidioidouria in this study. Isolating C. immitis from the urine may be helpful for diagnosis and should lead to further evaluation of the urinary tract for destructive parenchymal lesions. However, as an isolated finding, coccidioidouria does not always indicate the need for therapy.