Testing for Coccidioidomycosis among Patients with Community-Acquired Pneumonia

Abstract

Coccidioidomycosis is a common cause of communityacquired pneumonia (CAP) in disease-endemic areas. Because testing rates infl uence interpretation of reportable-disease data and quality of CAP patient care, we determined the proportion of CAP patients who were tested for Coccidioides spp., identifi ed testing predictors, and determined the proportion of tested patients who had positive coccidioidomycosis results. Cohort studies to determine the proportion of ambulatory CAP patients who were tested in 2 healthcare systems in metropolitan Phoenix found testing rates of 2% and 13%. A case-control study identifi ed signifi cant predictors of testing to be age >18 years, rash, chest pain, and symptoms for >14 days. Serologic testing confi rmed coccidioidomycosis in 9 (15%) of 60 tested patients, suggesting that the proportion of CAP caused by coccidioidomycosis was substantial. However, because Coccidioides spp. testing among CAP patients was infrequent, reportable-disease data, which rely on positive diagnostic test results, greatly underestimate the true disease prevalence.

Pathogenesis of Coccidioidomycosis

“…As much as one third of the cases of communityacquired pneumonia in highly endemic regions may be caused by Coccidioides spp. [2,3]. About 0.5 % of all infected persons will develop disease outside the lungs [4].…”

The Global Burden of Fungal Diseases

“…These estimates are likely to be gross underestimations of the actual burden because an estimated 60% of those with disease do not seek medical care, and many symptomatic infections go undiagnosed. 44 The incidence of disease in Central and South America has not been clearly defined. Skin testing surveys in Mexico found positivity rates between 40% and 90% in certain states, 45 indicating a high frequency of exposure to the fungus.…”

Beyond the superficial:Coccidioides immitisfungaemia in a man with fever, fatigue and skin nodules: a case of an emerging and evolving pathogen

“…A remarkable 804% increase in incidence has occurred over the past 15 years in Arizona and California in the USA, and in some regions Coccidiodes infection is a leading cause of community-acquired pneumonia 1 7 10 16. Geoclimatic and sociodemographic factors, including warmer temperatures, altered rainfall patterns, soil disturbance from land development, and changes in laboratory diagnostic and reporting practices are all considered contributory to this extraordinary increase 1 7…”