Coccidioidomycosis in African Americans

Abstract

Coccidioidomycosis is caused by Coccidioides species, a fungus endemic to the desert regions of the southwestern United States, and is of particular concern for African Americans. We performed a PubMed search of the English-language medical literature on coccidioidomycosis in African Americans and summarized the pertinent literature. Search terms were coccidioidomycosis, Coccidioides, race, ethnicity, African, black, and Negro. The proceedings of the national and international coccidioidomycosis symposia were searched. All relevant articles and their cited references were reviewed; those with epidemiological, immunologic, clinical, and therapeutic data pertaining to coccidioidomycosis in African Americans were included in the review. Numerous studies documented an increased predilection for severe coccidioidal infections, coccidioidomycosis-related hospitalizations, and extrapulmonary dissemination in persons of African descent; however, most of the published studies are variably problematic. The immunologic mechanism for this predilection is unclear. The clinical features and treatment recommendations are summarized. Medical practitioners need to be alert to the possibility of coccidioidomycosis in persons with recent travel to or residence in an area where the disease is endemic.

Dectin-1 Is Required for Resistance to Coccidioidomycosis in Mice

“…Compared to Caucasians, African Americans and Filipinos have a 5- to 10-fold-greater risk of developing disseminated coccidioidomycosis (14–16), which suggests that there is a genetic basis for susceptibility to sever coccidioidomycosis (17). Inbred mice also vary greatly in their susceptibility to coccidioidomycosis; DBA/2 (D2) mice are 1,000-fold more resistant than C57BL/6 (B6) and BALB/c mice, as determined by 50% lethal dose (LD 50 ) measurements (18, 19).…”

Reactivation of Coccidioidomycosis Despite Antifungal Prophylaxis in Solid Organ Transplant Recipients

“…African American race has long been a recognized risk factor in coccidioidomycosis for disseminated disease (2,18), severe infection requiring hospitalization (2,18), and coccidioidomycosis-related deaths (18,19) compared with persons of other racial backgrounds (Filipino persons also have an increased risk of dissemination [2]). The underlying mechanism for these observations is not understood but is presumed to have an immunologic basis (2,18). Our study included a single African American patient with disseminated infection before transplantation; the risk factors of race and dissemination are not clearly linked in our cohort, but this issue may be clarified with further study of future transplant recipients.…”

Management of temporomandibular joint Coccidioidomycosis

“…4,5 There is a greater predilection for dissemination in people of African descent, but the immunologic reason for this finding is unclear. 6 Most of the experience with treating coccidioidomycosis dissemination to bone comes from the orthopedic literature, which does not uniformly agree on the ideal management of this infectious process. 5,7 Only three cases involving the mandible of humans were identified in the literature.…”