Coccidioidomycosis

Clinical Features

Symptomatic infection (40% of cases) usually presents as flu-like illness with fever, cough, headaches, rash, and myalgias. Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting meninges, soft tissues, joints, and bone). Severe pulmonary disease may develop in HIV-infected persons.

Aetiologic Agent

Coccidioides immitis.

Reservoir

Soil in semiarid areas (primarily in the Lower Sonoran life zone). Endemic in the south-western United States, parts of Mexico and South America.

Incidence

Incidence was 15 cases per 100,000 population in Arizona in 1995. Of persons living in areas with endemic disease, 10-50% are skin-test positive.

Sequelae

Meningitis may lead to permanent neurologic damage. Mortality is high in HIV-infected persons with diffuse lung disease.

Transmission

Inhalation of airborne arthroconidia after disturbance of contaminated soil by humans or natural disasters (e.g., dust storms and earthquakes).

Risk Groups

Persons in areas with endemic disease who have occupations exposing them to dust (e.g., construction or agricultural workers, and archeologists). High risk groups are African-Americans and Asians, pregnant women during the third trimester, and immunocompromised persons.

Surveillance

National surveillance through NETSS started in 1995. Reportable in states with endemic disease: California, New Mexico, Arizona.

Challenges

Developing an effective vaccine (vaccination offers the best prevention measure because infection provides life-long immunity). Identifying factors associated with increased risk for dissemination in select racial groups to target prevention efforts.

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