An Unusual Outbreak of Windborne Coccidioidomycosis

Flynn, Neil; Hoeprich, Paul D.; Kawachi, Mildred M.; Lee, Kenneth K.; Lawrence, Ruth M.; Goldstein, Elliot; Jordan, George W.; Kundargi, Ronald S.; Wong, Gina

doi:10.1056/nejm197908163010705

Cited by 142 publications

(62 citation statements)

References 2 publications

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“…In a work published in 1946, Smith and Beard noted a 10-fold higher rate of disseminated coccidioidomycosis among AfricanAmerican men than among white men (118). After exposure of individuals due to a dust storm in California in 1977, Flynn and coworkers similarly demonstrated a 10-fold increased risk of disseminated disease among African-American men compared to white men (119). During the early 1990's, when the southern San Joaquin Valley was experiencing a dramatic increase in the number of cases of symptomatic coccidioidomycosis, Rosenstein and colleagues calculated an odds ratio of 4.6 for the risk for disseminated disease among African-Americans by using multivariable analysis (79,120).…”

Section: Characteristics Associated With Symptomatic Coccidioidomycosmentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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SUMMARY Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii . This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.

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Section: Characteristics Associated With Symptomatic Coccidioidomycosmentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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“…Although urbanization probably reduces the risk of infection by decreasing the surface area of exposed contaminated soil, it also increases the numbers of people who can potentially be infected by airborne arthroconidia that are generated by activities that disturb soil, such as construction and earthquakes [19,20]. In addition, windborne spores from an endemic area can infect people and animals many miles from the endemic area [21]. Coccidioides are salt tolerant so they may survive in coastal waters, and this could explain how they can infect marine mammals [7,22].…”

Section: Epidemiologymentioning

confidence: 99%

“…Fewer than 5% of immunocompetent patients develop disseminated disease [21,30]. Aside from disease or drug-induced immunosuppression, the risk of disseminated disease is strongly influenced by host factors, such as the third trimester of pregnancy and old age [30,31].…”

Section: Epidemiologymentioning

confidence: 99%

Coccidioides immitis and posadasii; A review of their biology, genomics, pathogenesis, and host immunity

Kirkland

Fierer

2018

Virulence

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Coccidioides immitis and C. posadasii are two highly pathogenic dimorphic fungal species that are endemic in the arid areas of the new world, including the region from west Texas to southern and central California in the USA that cause coccidioidomycosis (also known as Valley Fever). In highly endemic regions such as southern Arizona, up to 50% of long term residents have been infected. New information about fungal population genetics, ecology, epidemiology, and host-pathogen interactions is becoming available. However, our understanding of some aspects of coccidioidomycosis is still incomplete, including the extent of genetic variability of the fungus, the genes involved in virulence, and how the changes in gene expression during the organism’s dimorphic life cycle are related to the transformation from a free-living mold to a parasitic spherule. Unfortunately, efforts to develop an effective subunit vaccine have not yet been productive, although two potential live fungus vaccines have been developed.

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“…Others with high levels of soil exposure to soil are also at high risk, such as those participating in military training exercises [17]. Aside from the aforementioned weather-related variations in precipitation, other meteorological phenomena such as dust storms and earthquakes in endemic areas have been linked to outbreaks of coccidioidomycosis irrespective of a person's occupation or activity [18,19]. A high burden of disease has also been noted within state and federal correctional facilities [20].…”

Section: General Risk Factorsmentioning

confidence: 99%

“…One such study by Smith et al reported rates of dissemination among African Americans ten times that of Caucasian military personnel [32]. Another report supporting ethnic predilection for coccidioidomycosis under circumstances which accounted for differential exposure was an outbreak associated with a dust storm in Kern County, California [18]. Acute pulmonary disease in African Americans compared to Caucasians was documented at a rate of 67 vs. 19 per 100,000 while disseminated disease was noted in 23.8 vs. 2.5 per 100,000.…”

Section: Ethnicitymentioning

confidence: 99%

Update on the Epidemiology of Coccidioidomycosis

Stewart

Thompson

2016

Curr Fungal Infect Rep

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Coccidioidomycosis is an illness caused by the soildwelling, dimorphic fungi, Coccidioides immitis and Coccidioides posadasii, which are found primarily in niche ecological zones of the Western Hemisphere. The bulk of infections due to Coccidioides are found within the endemic areas of Arizona, California, Mexico, and Central America. Outcomes run the gamut from asymptomatic to a self-limited or even chronic pulmonary process, up to severe disseminated, and life-threatening disease. Patients at particular risk include the elderly, pregnant women, and members of certain ethnicities. Recent changes in the epidemiology and our overall understanding of coccidioidomycosis that pose a particular challenge to healthcare professionals include the rising incidence of disease, identification of infections thought to be acquired outside the previously described zones of endemicity, and the risks posed to the immunosuppressed population due to the increasing use of immunomodulatory pharmaceutical agents.

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An Unusual Outbreak of Windborne Coccidioidomycosis

Cited by 142 publications

References 2 publications

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Coccidioides immitis and posadasii; A review of their biology, genomics, pathogenesis, and host immunity

Update on the Epidemiology of Coccidioidomycosis

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