Approximately 60% of infected pts are asymptomatic; the remaining 40% have primarily pulmonary disease characterized by fever, cough, and pleuritic chest pain.

• Primary pulmonary infection is sometimes associated with erythema nodosum, erythema multiforme, arthralgias, and arthritis.
  • - A history of night sweats, profound fatigue, eosinophilia, and hilar or mediastinal lymphadenopathy suggests the disease.
  • - Pneumonic complications include pulmonary nodules (resembling pulmonary malignancies) and pulmonary cavities (a thin-walled lesion in a bronchus that is associated with cough, hemoptysis, and pleuritic chest pain).
• Disseminated infection affects <1% of infected pts, most commonly pts with depressed cellular immunity and pregnant women.
  • - Common sites for dissemination include bone, skin, joint, soft tissue, and meninges.
  • - Pts with meningitis present with persistent headache, lethargy, confusion, mild to moderate nuchal rigidity, and CSF with lymphocytic pleocytosis and profound hypoglycorrhachia. The mortality rate is ~100% without treatment.