Coccidioidomycosis in Arizona: Increase in Incidence from 1990 to 1995

Abstract

The number of cases of coccidioidomycosis (incidence) reported to the Arizona Department of Health Services increased from 255 (7.0 per 100,000 population) in 1990 to 623 (14.9 per 100,000 population) in 1995 (P < .001). Four counties in the south central region of the state, which contained 80% of the state's population, had the largest increase and accounted for 95% of all cases in 1995. Cases in persons aged 65 years or older and men were reported more frequently (for both, P < .001). During 1995, 890 patients were discharged from Arizona hospitals with a diagnosis of coccidioidomycosis. Rates of hospitalization were greater among persons aged 55 years or older, men, and African-American (for all three, P < .01). Of the hospitalized patients, 48 died, and 12 (25%) of these patients had a concurrent diagnosis of human immunodeficiency virus infection. These data demonstrate that coccidioidomycosis is a growing health problem in Arizona.

Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor α antagonists

“…Coccidioidomycosis is a common infection in the southwestern United States that has been increasing in incidence over the last decade (7,8). Cellular immunity plays a critical role in the host defense against this organism, as evidenced by the increased risk of severe coccidioidomycosis among those with depressed cellular immune function (9,10).…”

In Vitro Whole-Blood Analysis of Cellular Immunity in Patients with Active Coccidioidomycosis by Using the Antigen Preparation T27K

“…The average age of the patients with active coccidioidomycosis was nearly 67 years. While this appears old, recent data indicate that symptomatic coccidioidomycosis is far more prevalent among those aged 60 years and over than among younger subjects (4,21). Because all patients with active coccidioidomycosis at the medical center were referred to the coccidioidomycosis clinic and were eligible for study, the older age most likely reflects the predisposition for symptomatic illness among an older age group rather than any other factor.…”

Coccidioidomycosis in African Americans

“…50 Similarly, in a survey of data from Arizona from 1990 to 1995, rates of hospitalization were greater among African Americans (and among persons >55 years and male patients; all P<.01). 51 Other studies have identified an increased risk of death due to coccidioidomycosis in African Americans. A 1959 autopsy series 52 indicated that Negroes were disproportionately represented not only in coccidioidal dissemination but also in death compared with whites; a concurrent autopsy series showed that rates of death due to tuberculosis were similar between the races.…”