Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016

Abstract

Although coccidioidomycosis in Arizona and California has been well-characterized, much remains unknown about its epidemiology in states where it is not highly endemic. We conducted enhanced surveillance in 14 such states in 2016 by identifying cases according to the Council of State and Territorial Epidemiologists case definition and interviewing patients about their demographic characteristics, clinical features, and exposures. Among 186 patients, median time from seeking healthcare to diagnosis was 38 days (range 1–1,654 days); 70% had another condition diagnosed before coccidioidomycosis testing occurred (of whom 83% were prescribed antibacterial medications); 43% were hospitalized; and 29% had culture-positive coccidioidomycosis. Most (83%) patients from nonendemic states had traveled to a coccidioidomycosis-endemic area. Coccidioidomycosis can cause severe disease in residents of non–highly endemic states, a finding consistent with previous studies in Arizona, and less severe cases likely go undiagnosed or unreported. Improved coccidioidomycosis awareness in non–highly endemic areas is needed.

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

“…Although the CDC designates coccidioidomycosis as a reportable disease, reporting is dependent upon the participation of individual state departments of health. A recent report documented delays of up to four and a half years in accurately diagnosing patients with coccidioidomycosis who presented in states not known to be endemic for this disease [2]. It is possible that if Texas participated in the reporting of this disease, this child's infection might have been identified in a more timely manner.…”

“…In the United States, most reported infections originate from exposures in Arizona and California, but unexpected infection sources are continuing to be found elsewhere in the western USA [1]. Infections are also recognized outside of known endemic areas [2], usually associated with recent travel to and exposure in known endemic regions. Less frequently, they are reactivation during immunosuppression from a distant past infection or from transplantation of infected tissue.…”

Re-drawing the Maps for Endemic Mycoses

“…C. immitis is primarily found in the Central Valley of California but has now been found as far north as eastern Washington state [ 119 , 129 – 134 ]. C. posadasii, is found in the desert areas of Arizona, Texas, Utah, Mexico, and Central and South America [ 6 , 133 , 135 – 140 ]. However, there is geographic overlap between the two species in Southern California [ 122 ].…”

“…Turabelidze et al reported a fivefold increase in the incidence of cases in Missouri from 0.05 per 100,000 population in 2004 to 0.28 per 100,000 in 2013, with about a quarter of the cases either having no reported travel to the known endemic areas or no travel history [ 139 , 153 ]. Meanwhile, a surveillance study in 14 states by Benedict et al in 2016 identified Utah, Nevada, and New Mexico as low endemic areas compared to 11 other states including Missouri that were deemed non-endemic [ 135 ]. The study also highlighted the need for increased awareness of coccidioidomycoses in areas of low endemicity to avoid delay in its accurate diagnosis [ 135 ].…”

“…Meanwhile, a surveillance study in 14 states by Benedict et al in 2016 identified Utah, Nevada, and New Mexico as low endemic areas compared to 11 other states including Missouri that were deemed non-endemic [ 135 ]. The study also highlighted the need for increased awareness of coccidioidomycoses in areas of low endemicity to avoid delay in its accurate diagnosis [ 135 ].…”