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analyzed data. LT and KJ wrote the manuscript. All authors have read and approved the final manuscript.”
“Background Coccidioides immitis and posadasii are pathogenic fungi that grow in the arid soils of the southwestern United States, Mexico and Central and South America. Mycelia in the soil give rise to infectious arthroconidia, which, when aerosolized, can be inhaled. The severity of coccidioidomycois (Valley Fever) ranges from a mild self-limited disease to a severe pneumonia and widely disseminated infection requiring lifelong antifungal therapy . The risk factors for the more severe forms of disease include ethnic background (Filipino, African-American, Hispanic), male sex, increasing age, pregnancy and immunosuppression (HIV, malignancy, organ transplantation) [2–4]. The role of polymorphonuclear leukocytes (PMNs) macrophages and the oxidative burst in the defense against Coccidioides is not clearly defined. PMN’s are the first cell to respond to inhaled arthroconidia . Although arthroconidia are sensitive to products of the oxidative burst [6, 7] and are phagocytosed by PMNs [8–10], fewer than 20% of arthroconidia are killed by human PMNs [8, 9, 11, 7].