Coccidioidal Pneumonia, Phoenix, Arizona, USA, 2000–2004

Abstract

Community-acquired pneumonia (CAP) often results in severe illness and death. In large, geographically defi ned areas where Coccidioides spp. are endemic, coccidioidomycosis is a recognized cause of CAP, but its frequency has not been studied extensively. To determine the frequency of patients with coccidioidomycosis, we conducted a prospective evaluation of 59 patients with CAP in the Phoenix, Arizona, area. Of 35 for whom paired coccidioidal serologic testing was performed, 6 (17%) had evidence of acute coccidioidomycosis. Coccidioidal pneumonia was more likely than noncoccidioidal CAP to produce rash. The following were not found to be risk factors or reliable predictors of infection: demographic features, underlying medical conditions, duration of time spent in disease-endemic areas, occupational and recreational activities, initial laboratory studies, and chest radiography fi ndings. Coccidioidomycosis is a common cause of CAP in our patient population. In the absence of distinguishing clinical features, coccidioidal pneumonia can be identifi ed only with appropriate laboratory studies.

Progress Toward a Human Vaccine Against Coccidioidomycosis

“…Clinical investigations have revealed that reactivation of coccidioidomycosis in people who initially have an asymptomatic coccidioidal infection can occur months to years after exposure to the pathogen during a visit to an endemic site [8•]. Major outbreaks of coccidioidomycosis continue to occur, particularly in California and Arizona [9, 10]. For example, a huge dust storm that swept through Phoenix on 5 July 2011 resulted in a significant rise in the number of symptomatic infections during the following 4-month period (http://www.vfce.arizona.edu/resources/pdf/SunenshineMD-AM_CME_Cocci_Epi_11_6_11.pdf).…”

A Genetically Engineered Live Attenuated Vaccine ofCoccidioides posadasiiProtects BALB/c Mice against Coccidioidomycosis

“…Valdivia and coworkers (50) reported that 29% of patients diagnosed with CAP in Tucson, AZ, had contracted coccidioidomycosis. Physicians are strongly advised to consider Coccidioides infection in their differential diagnosis of all patients with CAP who reside in or have recently visited a region to which coccidioidal disease is endemic (26). Coccidioidal infections can progress to life-threatening, chronic progressive pneumonia, extrapulmonary nonmeningeal disease, or meningitis, the most feared complication of coccidioidomycosis (36).…”

Molecular detection of airborne Coccidioides in Tucson, Arizona

“…9–11 Once inside the host, Coccidioides produces spherules, specialized parasitic structures that reinfect host tissues and disseminate inside the host. 12 In most cases, infection is asymptomatic, and the majority of symptomatic cases present as a flu-like illness; 13,14 however, some cases can result in a chronic or disseminated life-threatening disease. 15 …”