Coccidioidomycosis Outbreaks, United States and Worldwide, 1940–2015

Abstract

Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940–2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public.

Detection and Control of Fungal Outbreaks

“…Outbreaks caused by fungi can be classified into two groups. The first consists of community-acquired outbreaks that are linked to outdoor activities, mostly seen in patients who perform a specific occupational or recreational activity and those who experienced a natural disaster or human conflicts [ 9 – 12 ]. The second group of fungal outbreaks is related to hospital care and has been increasingly reported during the past two decades, likely as a result of the increase in at-risk populations [ 13 ].…”

“…The second group of fungal outbreaks is related to hospital care and has been increasingly reported during the past two decades, likely as a result of the increase in at-risk populations [ 13 ]. The sources of healthcare-associated outbreaks include construction near or renovation of healthcare facilities, contamination of water and ventilation systems, medicines and medical devices, and gaps in infection prevention measures [ 9 – 12 , 14 , 15 ]. An increasingly reported cause of fungal outbreaks is the emergence of novel resistant pathogens within hospital environments, clearly exemplified by the unprecedented emergence of Candida auris , as well as increasing incidence of previously rare resistant species like Candida krusei and Diutina rugosa [ 16 – 19 ].…”

Coccidioidomycosis Outbreak Among Workers Constructing a Solar Power Farm — Monterey County, California, 2016–2017

“…Underrecognition, misdiagnosis, and substantial delays between seeking health care and accurate diagnosis are common ( 7 ). Outdoor workers performing soil-disturbing activities in areas where Coccidioides is endemic are particularly at risk for infection, and approximately half of all reported outbreaks have involved occupational exposures ( 8 ), including outbreaks among workers constructing two solar farms in San Luis Obispo County, California, during 2011–2014 ( 2 , 3 ).…”

The mysterious desert dwellers:Coccidioides immitis and Coccidioides posadasii, causative fungal agents of coccidioidomycosis

“…African Americans, Filipinos, pregnant women, and those with immunosuppressed conditions are well-documented groups at higher risk for dissemination [105][106][107][108][109][110][111][112][113][114][115]. Occupational exposures, such as working in construction, farm work, outdoor filing, solar farms, or archeological digs, have been associated with larger outbreaks among these workers [43,[116][117][118][119][120][121][122]. Additionally, prison inmates and guards/workers in the endemic regions have high rates of exposure and disease [106,107,[123][124][125][126].…”