Expanding Understanding of Epidemiology of Coccidioidomycosis in the Western Hemisphere

Abstract

Coccidioidomycosis is a disease of both national and worldwide importance that is most often diagnosed in nonendemic regions. The endemic region for Coccidioides spp. lies exclusively in the Western Hemisphere. Coccidioides spp. has long been identified in semiarid areas of the United States and Mexico, and endemic foci have been described in areas of Central and South America. Infection is usually the result of activities that cause the fungus to become airborne and inhaled by a susceptible host. Underlying medical diseases that affect T cell function are known to increase the risk of disseminated disease and include human immunodeficiency virus, cancer, and disease processes requiring transplantation and its subsequent immunosuppressive agents. In recent years the incidence of the coccidioidomycosis has increased in California and Arizona, which may be partially due to the massive migration of Americans to the Sunbelt states. To date the highest number of cases reported in Arizona was in 2004, when a total of 3,665 cases of coccidioidomycosis was reported, representing a 281% increase since 1997. Statistics on the prevalence and incidence of coccidioidomycosis in Latin America either are fragmentary or simply are not available.

Coccidioidomycosis in African Americans

“…For example, from 2000 to 2008, the population in Arizona increased 26% to more than 6.5 million persons. 11,12 During that same period, the number of African American residents in Arizona increased by 73%. 12 The Southwest also serves as a winter vacation destination for an increasing number of travelers and part-time residents, who may return home after having acquired the infection.…”

“…12 The Southwest also serves as a winter vacation destination for an increasing number of travelers and part-time residents, who may return home after having acquired the infection. 11,13 An estimated 150,000 new cases of coccidioidomycosis infection occur each year. 11,[13][14][15] Most (>95%) occur in California and Arizona 6 ; 60% occur in Arizona.…”

Call for a California Coccidioidomycosis Consortium to Face the Top Ten Challenges Posed by a Recalcitrant Regional Disease

“…Some of the areas into which the new migrants are moving were not known previously to be highly endemic for Coccidioides species. However, a high incidence of the disease is being reported from several ''non-endemic'' areas [18]. Therefore, it is reasonable to assume that the fungus is spreading within California.…”

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

“…Coccidioides spp., which consist of the nearly identical Coccidioides immitis and C. posadasii that grow in the soils of the desert southwestern United States and in limited areas of Central and South America (1). When soil is disrupted, airborne arthroconidia can be inhaled, causing infections in humans and animals.…”