“…The disease is caused by the fungal pathogen Coccidioides immitis [48] and is marked by skin lesions and the potentially fatal formation of granulomas in numerous organs. At first, the pathogen was considered to be limited to arid desert regions in the United States and Argentina [49], however, wider surveillance has detected the fungus in other geographic regions of the United States including Arkansas [50], Utah [51], Arizona [52], Texas [53] as well as in Canada [54,55], Central and South America [56]. In addition, a retrospective analysis of coccidioidomycosis in China revealed 38 cases involving no history or travel to endemic areas [57] suggesting the fungus already may be spreading globally with no defined routes identified.…”