Coccidioidal Meningitis in New York Traced to Texas by Fungal Genomic Analysis

Barker, Bridget M.; Rajan, Sujatha; Teixeira, Marcus de Melo; Sewnarine, Michelle; Roe, Chandler C.; Engelthaler, David M.; Galgiani, John N.

doi:10.1093/cid/ciz052

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…It is possible that some positive Coccidioides tests, particularly for IgG alone, represent past infection; however, Coccidioides IgG does not persist long after the initial infection and is often used for the diagnosis of recent infections [53,54]. Houston is >100 miles east of areas of Texas with documented locally acquired coccidioidomycosis cases of an outbreak in Beeville, Texas [55]; it is also much farther northeast and much wetter than areas considered highly endemic in West Texas and along the Rio Grande Valley. However, the endemic area for coccidioidomycosis remains poorly defined and may be changing over time.…”

Section: Discussionmentioning

confidence: 99%

Fungal Pathogens as Causes of Acute Respiratory Illness in Hospitalized Veterans: Frequency of Fungal Positive Test Results Using Rapid Immunodiagnostic Assays

Cáceres

Rodriguez‐Barradas

Whitaker

et al. 2023

JoF

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Fungal respiratory illnesses caused by endemic mycoses can be nonspecific and are often mistaken for viral or bacterial infections. We performed fungal testing on serum specimens from patients hospitalized with acute respiratory illness (ARI) to assess the possible role of endemic fungi as etiologic agents. Patients hospitalized with ARI at a Veterans Affairs hospital in Houston, Texas, during November 2016–August 2017 were enrolled. Epidemiologic and clinical data, nasopharyngeal and oropharyngeal samples for viral testing (PCR), and serum specimens were collected at admission. We retrospectively tested remnant sera from a subset of patients with negative initial viral testing using immunoassays for the detection of Coccidioides and Histoplasma antibodies (Ab) and Cryptococcus, Aspergillus, and Histoplasma antigens (Ag). Of 224 patient serum specimens tested, 49 (22%) had positive results for fungal pathogens, including 30 (13%) by Coccidioides immunodiagnostic assays, 19 (8%) by Histoplasma immunodiagnostic assays, 2 (1%) by Aspergillus Ag, and none by Cryptococcus Ag testing. A high proportion of veterans hospitalized with ARI had positive serological results for fungal pathogens, primarily endemic mycoses, which cause fungal pneumonia. The high proportion of Coccidioides positivity is unexpected as this fungus is not thought to be common in southeastern Texas or metropolitan Houston, though is known to be endemic in southwestern Texas. Although serological testing suffers from low specificity, these results suggest that these fungi may be more common causes of ARI in southeast Texas than commonly appreciated and more increased clinical evaluation may be warranted.

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Section: Discussionmentioning

confidence: 99%

Fungal Pathogens as Causes of Acute Respiratory Illness in Hospitalized Veterans: Frequency of Fungal Positive Test Results Using Rapid Immunodiagnostic Assays

Cáceres

Rodriguez‐Barradas

Whitaker

et al. 2023

JoF

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“…However, the lack of FDA-approved solutions, rigorous technical requirements, and high start-up costs currently limit the widespread implementation of these assays in clinical laboratories. Outside clinical laboratories, NGS has also been used in outbreak investigations and can reliably link isolates epidemiologically (52,53). Similarly, differentiation between C. immitis and C. posadasii is neither clinically necessary nor possible using most available diagnostic modalities, but it is achievable using molecular approaches like NGS.…”

Section: Molecular Methodsmentioning

confidence: 99%

Review of Clinical and Laboratory Diagnostics for Coccidioidomycosis

2023

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Coccidioidomycosis is a fungal disease associated with soil exposure that frequently goes undiagnosed due at least in part to its nonspecific presentation and the lack of clinical suspicion by health care providers. Currently available diagnostics for coccidioidomycosis offer qualitative results that can suffer from low specificity, while semiquantitative assays are labor-intensive and complex and can require multiple days to complete.

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“…In that study, most patients had either traveled to coccidioidomycosis-endemic regions during the 4 months before symptom onset or visited or previously resided in an endemic region at some point during their lifetimes. Previous studies ( 3 , 15 ) have shown that isolates can be traced to their place of origin by applying current understanding of Coccidioides phylogeography to the increasing number of publicly available genomes. We determined to further investigate the isolates from cases described in the 2016 enhanced surveillance by using genomic epidemiology to empirically evaluate the original findings and identify likely origins of coccidioidomycosis cases in nonendemic regions.…”

mentioning

confidence: 99%

Genomic Epidemiology Linking Nonendemic Coccidioidomycosis to Travel

Monroy-Nieto¹,

Gade²,

Benedict³

et al. 2023

Emerg. Infect. Dis.

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C occidioides immitis and C. posadasii, the etiologic agents of coccidioidomycosis, also known as Valley fever, are environmental filamentous fungi with distinct geographic ranges in the western United States, northern Mexico, and parts of Central and South America (1,2). In 2015, C. immitis was discovered in Washington, USA (3). That discovery highlighted the importance of using molecular detection methods (3,4) and enhanced efforts to study Coccidioides spp. outside traditionally identified endemic areas. Finding that Coccidioides might exist outside its previously established endemic regions supports the hypothesis that the geographic range of this pathogen may be changing (5).In recent years, genomic analyses of this pathogenic genus uncovered strong phylogeographic structure and delineated populations associated with specific geographic regions, findings that expand previous work based on immunological studies (6) and molecular studies using traditional, less-discerning methods (7). C. immitis is found primarily in California and Washington, C. posadasii in Arizona, Texas, Mexico, and Central and South America (8). Within species, population structure has been characterized, separating the Washington isolates from other C. immitis strains (3,9) and dividing C. posadasii into several differentiated phylogeographic clades (10), including the Arizona and Texas/Mexico/South America (TX/ MX/SA) clades, and a more recently delimited Guatemala/Venezuela clade (11). Although no phenotypic distinction between these groups has been associated with disease outcome, the genetic differences and population structures among these clades represent considerable assets for molecular epidemiology and enable tracking of the origins of infections.Coccidioides spp. can infect several species of mammals, including humans. Both immunocompromised and immunocompetent persons can develop coccidioidomycosis by inhaling airborne propagules from disturbed soil (2). In human hosts, symptoms range from inconsequential to self-limited and often protracted respiratory illness to chronic pulmonary disorders and, in rare cases, disseminated systemic infections (12,13). In the United States, >10,000 new cases/year have been reported to public health authorities in recent years, mainly in Arizona and California (13,14). Those states are also thought to be the source of most travel-related infections, as confirmed by the results of enhanced surveillance from 2016 describing clinical and epidemiologic characteristics of reported cases from 14 coccidioidomycosis nonendemic states (12). In that study, most patients had either traveled to coccidioidomycosis-endemic regions

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Coccidioidal Meningitis in New York Traced to Texas by Fungal Genomic Analysis

Cited by 10 publications

References 14 publications

Fungal Pathogens as Causes of Acute Respiratory Illness in Hospitalized Veterans: Frequency of Fungal Positive Test Results Using Rapid Immunodiagnostic Assays

Fungal Pathogens as Causes of Acute Respiratory Illness in Hospitalized Veterans: Frequency of Fungal Positive Test Results Using Rapid Immunodiagnostic Assays

Review of Clinical and Laboratory Diagnostics for Coccidioidomycosis

Genomic Epidemiology Linking Nonendemic Coccidioidomycosis to Travel

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