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Kumar RN, Gorsline CA, Rader T, Boucher HW, Malinis M, Koff A, Harris CE. The pre-transplant evaluation: Considerations for trainees and early career transplant infectious diseases clinician. Transpl Infect Dis 2024:e14326. [PMID: 38967408 DOI: 10.1111/tid.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/26/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
Transplant infectious disease (TID) clinicians are integral to the pre-transplantation evaluation. Pre-transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre-transplant evaluation. This article reviews the details of performing successful pre-transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians.
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Affiliation(s)
- Rebecca N Kumar
- Division of Infectious Disease and Tropical Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Chelsea A Gorsline
- Division of Infectious Disease, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Theodore Rader
- Division of Infectious Diseases and Immunology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tuft University School of Medicine, Boston, Massachusetts, USA
| | - Maricar Malinis
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Alan Koff
- Division of Infectious Diseases, University of California, Davis, Sacramento, California, USA
| | - Courtney E Harris
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Casalini G, Giacomelli A, Antinori S. The WHO fungal priority pathogens list: a crucial reappraisal to review the prioritisation. THE LANCET. MICROBE 2024; 5:717-724. [PMID: 38608682 DOI: 10.1016/s2666-5247(24)00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/14/2024]
Abstract
In October, 2022, WHO published the first fungal priority pathogen list, which categorised 19 fungal entities into three priority groups (critical, high, and medium), for prioritisation of research efforts. The final ranking was determined via multiple criteria decision analysis, considering both research and development needs and perceived public health importance. In this Personal View, we discuss the positioning of the fungal pathogens, namely, Mucorales, Candida spp, Histoplasma spp, Coccidioides and Paracoccidioides spp, Fusarium spp, eumycetoma causative agents, Talaromyces marneffei, and Pneumocystis jirovecii, while expressing concerns about potential disparities between the WHO fungal priority pathogen list ranking and the actual disease burden associated with these pathogens. Finally, we propose a revised prioritisation list that also considers the regional disparities in the burden of fungal diseases.
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Affiliation(s)
- Giacomo Casalini
- Department of Biomedical and Clinical Sciences, DIBIC, Università degli Studi di Milano, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, DIBIC, Università degli Studi di Milano, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy.
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3
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Morris AJ, Kim HY, Nield B, Dao A, McMullan B, Alastruey-Izquierdo A, Colombo AL, Heim J, Wahyuningsih R, Le T, Chiller TM, Forastiero A, Chakrabarti A, Harrison TS, Bongomin F, Galas M, Siswanto S, Dagne DA, Roitberg F, Gigante V, Beardsley J, Sati H, Alffenaar JW, Morrissey CO. Talaromyces marneffei, Coccidioides species, and Paracoccidioides species-a systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myad133. [PMID: 38935909 PMCID: PMC11210613 DOI: 10.1093/mmy/myad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 06/29/2024] Open
Abstract
The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal pathogen priority list. This systematic review aimed to evaluate the epidemiology and impact of infections caused by Talaromyces marneffei, Coccidioides species, and Paracoccidioides species. PubMed and Web of Sciences databases were searched to identify studies published between 1 January 2011 and 23 February 2021 reporting on mortality, complications and sequelae, antifungal susceptibility, preventability, annual incidence, and trends. Overall, 25, 17, and 6 articles were included for T. marneffei, Coccidioides spp. and Paracoccidioides spp., respectively. Mortality rates were high in those with invasive talaromycosis and paracoccidioidomycosis (up to 21% and 22.7%, respectively). Hospitalization was frequent in those with coccidioidomycosis (up to 84%), and while the duration was short (mean/median 3-7 days), readmission was common (38%). Reduced susceptibility to fluconazole and echinocandins was observed for T. marneffei and Coccidioides spp., whereas >88% of T. marneffei isolates had minimum inhibitory concentration values ≤0.015 μg/ml for itraconazole, posaconazole, and voriconazole. Risk factors for mortality in those with talaromycosis included low CD4 counts (odds ratio 2.90 when CD4 count <200 cells/μl compared with 24.26 when CD4 count <50 cells/μl). Outbreaks of coccidioidomycosis and paracoccidioidomycosis were associated with construction work (relative risk 4.4-210.6 and 5.7-times increase, respectively). In the United States of America, cases of coccidioidomycosis increased between 2014 and 2017 (from 8232 to 14 364/year). National and global surveillance as well as more detailed studies to better define sequelae, risk factors, outcomes, global distribution, and trends are required.
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Affiliation(s)
- Arthur J Morris
- Department of Microbiology, Auckland City Hospital, Te Toku Tumai, Grafton, Auckland, New Zealand
| | - Hannah Yejin Kim
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Blake Nield
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Aiken Dao
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Brendan McMullan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Arnaldo Lopes Colombo
- Departamento de Medicina, Division of Infectious Diseases, Hospital São Paulo, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jutta Heim
- Global Antibiotics Research and Development Partnership, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen, Jakarta, Indonesia
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Tropical Medicine Research Center for Talaromycosis, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Agustina Forastiero
- Department of Communicable Diseases Prevention, Control and Elimination, Pan American Health Organization,Washington, DC, USA
| | | | - Thomas S Harrison
- Institute for Infection and Immunity, and Clinical Academic Group in Infection and Immunity, St. George’s, University of London, and St. George’s University Hospitals NHS Foundation Trust, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
| | - Siswanto Siswanto
- World Health Organization, South-East Asia Region Office, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Valeria Gigante
- Impact Initiatives and Research Coordination Unit, Global Coordination Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Justin Beardsley
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hatim Sati
- Impact Initiatives and Research Coordination Unit, Global Coordination Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Jan-Willem Alffenaar
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Catherine Orla Morrissey
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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Román-Montes CM, Seoane-Hernández L, Flores-Miranda R, Tello-Mercado AC, Rangel-Cordero A, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A, González-Lara F. Coccidioidomycosis in Immunocompromised at a Non-Endemic Referral Center in Mexico. J Fungi (Basel) 2024; 10:429. [PMID: 38921414 PMCID: PMC11205067 DOI: 10.3390/jof10060429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.
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Affiliation(s)
- Carla M. Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - Lisset Seoane-Hernández
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Rommel Flores-Miranda
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Andrea Carolina Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - Rosa Areli Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
| | - Fernanda González-Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (C.M.R.-M.); (A.C.T.-M.); (A.P.-d.-L.)
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico (R.A.M.-G.)
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5
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Seidel D, Wurster S, Jenks JD, Sati H, Gangneux JP, Egger M, Alastruey-Izquierdo A, Ford NP, Chowdhary A, Sprute R, Cornely O, Thompson GR, Hoenigl M, Kontoyiannis DP. Impact of climate change and natural disasters on fungal infections. THE LANCET. MICROBE 2024; 5:e594-e605. [PMID: 38518791 DOI: 10.1016/s2666-5247(24)00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Abstract
The effects of climate change and natural disasters on fungal pathogens and the risks for fungal diseases remain incompletely understood. In this literature review, we examined how fungi are adapting to an increase in the Earth's temperature and are becoming more thermotolerant, which is enhancing fungal fitness and virulence. Climate change is creating conditions conducive to the emergence of new fungal pathogens and is priming fungi to adapt to previously inhospitable environments, such as polluted habitats and urban areas, leading to the geographical spread of some fungi to traditionally non-endemic areas. Climate change is also contributing to increases in the frequency and severity of natural disasters, which can trigger outbreaks of fungal diseases and increase the spread of fungal pathogens. The populations mostly affected are the socially vulnerable. More awareness, research, funding, and policies on the part of key stakeholders are needed to mitigate the effects of climate change and disaster-related fungal diseases.
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Affiliation(s)
- Danila Seidel
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Sebastian Wurster
- ECMM Excellence Center for Medical Mycology, Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Jeffrey D Jenks
- Durham County Department of Public Health, Durham, NC, USA; Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| | - Hatim Sati
- Department of Global Coordination and Partnership on Antimicrobial Resistance, WHO, Geneva, Switzerland
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses Chroniques, ECMM Excellence Center for Medical Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France; University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail) - UMR_S 1085, Rennes, France
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nathan P Ford
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India; National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver Cornely
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Koln), University of Cologne, Cologne, Germany
| | - George R Thompson
- University of California Davis Center for Valley Fever, University of California Davis, Sacramento, CA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA; Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed, Graz, Austria.
| | - Dimitrios P Kontoyiannis
- ECMM Excellence Center for Medical Mycology, Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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Wilson DL, Kollampare S, Kwoh CK, Zhou L, Ashbeck EL, Sudano D, Lupi M, Miller A, Smith K, Lo‐Ciganic W. Coccidioides Serologic Screening Practices in Individuals With Rheumatic and Autoimmune Diseases. ACR Open Rheumatol 2024; 6:380-387. [PMID: 38477182 PMCID: PMC11168914 DOI: 10.1002/acr2.11663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE We aimed to estimate Coccidioides serologic screening rates before initiation of biologic disease-modifying antirheumatic drugs including tofacitinib (b/tsDMARDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and/or noninhaled corticosteroids. METHODS This retrospective cohort study used 2011 to 2016 US Medicare claims data and included beneficiaries with rheumatic or autoimmune disease residing in regions within Arizona, California, and Texas endemic for Coccidioides spp. with ≥1 prescription for a b/tsDMARD, csDMARD, and/or noninhaled corticosteroid. We estimated prior-year serologic screening incidence before initiating b/tsDMARDs, csDMARD, and/or noninhaled corticosteroid. RESULTS During 2012 to 2016, 4,331 beneficiaries filled 64,049 prescriptions for b/tsDMARDs, csDMARDs, and noninhaled corticosteroids. Arizona's estimated screening rate was 20.1% (95% confidence interval [95% CI] 14.5-25.7) in the year before prescription initiation for b/tsDMARDs, 8.1% (95% CI 6.5-9.7) before csDMARDs, and 6.9% (95% CI: 5.6-8.2) before corticosteroids. Screening rates for b/tsDMARDs (2.8%, 95% CI 0.0-6.7), csDMARDs (1.0%, 95% CI 0.0-2.0), and corticosteroids (0.8%, 95% CI: 0.4-1.1) were negligible in California and undetected in Texas. Adjusted screening rate before prescription for b/tsDMARDs in Arizona increased from 14.5% (95% CI 7.5-21.5) in 2012 to 26.7% (95% CI 17.6-35.8) in 2016. Rheumatologists prescribing b/tsDMARDs in Arizona screened more than other providers (20.9% [95% CI 13.9-27.9] vs 12.9% [95% CI 5.9-20.0]). CONCLUSION Coccidioides serologic screening rates among Medicare beneficiaries with rheumatic/autoimmune diseases on b/tsDMARDs, csDMARDs, and noninhaled corticosteroids was low in Coccidioides spp.-US endemic regions between 2012 and 2016. Alignment of screening recommendations and clinical practice is needed.
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Affiliation(s)
| | | | - C. Kent Kwoh
- University of Arizona and The University of Arizona Arthritis CenterTucson
| | - Lili Zhou
- The University of Arizona Arthritis CenterTucson
| | | | - Dominick Sudano
- University of Arizona and The University of Arizona Arthritis CenterTucson
| | | | | | | | - Wei‐Hsuan Lo‐Ciganic
- University of Pittsburgh, Pittsburgh, Pennsylvania, and Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health SystemGainesvilleFlorida
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7
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Novick LR, Liu J. Seeing what you believe: recognition memory for evolutionary tree structure is affected by students' misconceptions. Memory 2024:1-15. [PMID: 38805606 DOI: 10.1080/09658211.2024.2360567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
Peoples' recognition memory for pictorial stimuli is extremely good. Even complex scientific visualisations are recognised with a high degree of accuracy. The present research examined recognition memory for the branching structure of evolutionary trees. This is an educationally consequential topic due to the potential for contamination from students' misconceptions. The authors created six pairs of scientifically accurate and structurally identical evolutionary trees that differed in whether they included a taxon that cued a misconception in memory. As predicted, Experiment 1 found that (a) college students (N = 90) had better memory for each of the six tree structures when a neutral taxon (M = 0.73) rather than a misconception-cuing taxon (M = 0.64) was included in the tree, and (b) recognition memory was significantly above chance for both sets of trees. Experiment 2 ruled out an alternative hypothesis based on the possibility that 8-12 sec was not enough time for students to encode the relationships depicted in the trees. The authors consider implications of these results for using evolutionary trees to better communicate scientific information. This is important because these trees provide information that is relevant for everyday life.
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Affiliation(s)
- Laura R Novick
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Jingyi Liu
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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8
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Machiavello Roman FJ, Pischel L, Azar MM. Lung infections due to emerging fungal pathogens. Curr Opin Pulm Med 2024; 30:258-265. [PMID: 38411158 DOI: 10.1097/mcp.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms. RECENT FINDINGS Emerging fungal infections have arisen as a result of population and environmental changes. An enlarging pool of immunocompromised hosts on triazole antifungal prophylaxis has led to an increased incidence of non- Aspergillus molds, such as Fusarium , Scedosporium and Lomentospora spp. Advances in diagnostic capabilities led to the identification of the Emergomyces genus and non- dermatitidis Blastomyces species, which have a significant disease burden in Africa and the Middle East. Climate change has contributed to changing the distribution of previously confined endemic mycoses, like coccidioidomycosis and talaromycosis. These emerging organisms pose important diagnostic and therapeutic challenges. SUMMARY Newly recognized pathogenic fungi and established endemic mycoses with expanding geographic boundaries have become important agents of pulmonary disease. There is a dearth of clinical evidence on the appropriate management of these infections.
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Affiliation(s)
| | | | - Marwan M Azar
- Department of Medicine, Section of Infectious Diseases and Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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9
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Williams SL, Toda M, Chiller T, Brunkard JM, Litvintseva AP. Effects of climate change on fungal infections. PLoS Pathog 2024; 20:e1012219. [PMID: 38814855 PMCID: PMC11139277 DOI: 10.1371/journal.ppat.1012219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- Samantha L. Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joan M. Brunkard
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anastasia P. Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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10
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Mayfield H, Davila V, Penedo E. Coccidioidomycosis-Related Hospital Visits, Texas, USA, 2016-2021. Emerg Infect Dis 2024; 30:882-889. [PMID: 38666577 PMCID: PMC11060464 DOI: 10.3201/eid3005.231624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
We analyzed hospital discharge records of patients with coccidioidomycosis-related codes from the International Classification of Diseases, 10th revision, Clinical Modification, to estimate the prevalence of hospital visits associated with the disease in Texas, USA. Using Texas Health Care Information Collection data for 2016-2021, we investigated the demographic characteristics and geographic distribution of the affected population, assessed prevalence of hospital visits for coccidioidomycosis, and examined how prevalence varied by demographic and geographic factors. In Texas, 709 coccidioidomycosis-related inpatient and outpatient hospital visits occurred in 2021; prevalence was 3.17 cases per 100,000 total hospital visits in 2020. Geographic location, patient sex, and race/ethnicity were associated with increases in coccidioidomycosis-related hospital visits; male, non-Hispanic Black, and Hispanic patients had the highest prevalence of coccidioidomycosis compared with other groups. Increased surveillance and healthcare provider education and outreach are needed to ensure timely and accurate diagnosis and treatment of coccidioidomycosis in Texas and elsewhere.
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Scott B, Sassine J, Gordon O, Agudelo Higuita NI. Coccidioidomycosis in Oklahoma: A retrospective case series. Mycoses 2024; 67:e13749. [PMID: 38782759 DOI: 10.1111/myc.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Coccidioidomycosis is a systemic fungal disease endemic to arid regions of the Western Hemisphere. In the south-western US, Coccidioides spp. may account for up to 20%-25% of all cases of community acquired pneumonia. Clinical manifestations vary widely, from asymptomatic infection to life-threatening disease, especially in immunocompromised hosts. OBJECTIVES The primary objective of the study was to characterise cases of coccidioidomycosis in an area of the United States not considered traditionally endemic for the disease. METHODS We performed a single-centre retrospective study of all cases of coccidioidomycosis from 1 January 2000 to 31 December 2020, in the University of Oklahoma Health Sciences Medical Center. RESULTS A total of 26 patients were included for analysis. The central nervous system (CNS) and the lungs were the sites most frequently involved. Twenty (77%) had travelled to a coccidioidomycosis endemic region. Most were male (81%) with a median age of 42 years (range: 3-78 years). The majority (46%) were Caucasians, 19% were African American, 19% Hispanic, and 12% Native American. The most common comorbidities were diabetes mellitus and acquired immunodeficiency syndrome, identified in 27% and 23% of patients, respectively. Patients on immunosuppressive therapy accounted for 12% of all cases. CONCLUSION Our study is one of the largest single-centre case series of coccidioidomycosis from a non-endemic area. Diabetes mellitus was the most frequent comorbidity. Compared to other case series of coccidioidomycosis, our patient population had higher rates of immunosuppression and had both a higher rate of disseminated disease and overall mortality.
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Affiliation(s)
- Brian Scott
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph Sassine
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Olivia Gordon
- Department of Medicine, Section of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Nelson Iván Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Instituto de Enfermedades Tropicales y Parasitología Antonio Vidal, Tegucigalpa, Honduras
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12
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Koehler MA, Song L, Grill FJ, Shubitz LF, Powell DA, Galgiani JN, Orbach MJ, Robb EJ, Chung Y, Williams SA, Murugan V, Park JG, LaBaer J, Lake DF, Magee DM. Discovery of a Unique Set of Dog-Seroreactive Coccidioides Proteins Using Nucleic Acid Programmable Protein Array. J Fungi (Basel) 2024; 10:307. [PMID: 38786662 PMCID: PMC11121964 DOI: 10.3390/jof10050307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Valley Fever (VF), caused by fungi in the genus Coccidioides, is a prevalent disease in southwestern and western parts of the United States that affects both humans and animals, such as dogs. Although the immune responses to infection with Coccidioides spp. are not fully characterized, antibody-detection assays are used in conjunction with clinical presentation and radiologic findings to aid in the diagnosis of VF. These assays often use Complement Fixation (CF) and Tube Precipitin (TP) antigens as the main targets of IgG and IgM reactivity, respectively. Our group previously reported evidence of over 800 genes expressed at the protein level in C. posadasii. However, antibody reactivity to the majority of these proteins has never been explored. Using a new, high-throughput screening technology, the Nucleic Acid Programmable Protein Array (NAPPA), we screened serum specimens from dogs against 708 of these previously identified proteins for IgG reactivity. Serum from three separate groups of dogs was analyzed and revealed a small panel of proteins to be further characterized for immuno-reactivity. In addition to CF/CTS1 antigen, sera from most infected dogs showed antibody reactivity to endo-1,3-betaglucanase, peroxisomal matrix protein, and another novel reactive protein, CPSG_05795. These antigens may provide additional targets to aid in antibody-based diagnostics.
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Affiliation(s)
- Megan A. Koehler
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA;
| | - Lusheng Song
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
| | | | - Lisa F. Shubitz
- Valley Fever Center for Excellence, The University of Arizona, Tucson, AZ 85724, USA; (L.F.S.); (D.A.P.); (J.N.G.); (M.J.O.)
- BIO5 Institute, The University of Arizona, Tucson, AZ 85724, USA
| | - Daniel A. Powell
- Valley Fever Center for Excellence, The University of Arizona, Tucson, AZ 85724, USA; (L.F.S.); (D.A.P.); (J.N.G.); (M.J.O.)
- BIO5 Institute, The University of Arizona, Tucson, AZ 85724, USA
- Department of Immunobiology, The University of Arizona, Tucson, AZ 85724, USA
| | - John N. Galgiani
- Valley Fever Center for Excellence, The University of Arizona, Tucson, AZ 85724, USA; (L.F.S.); (D.A.P.); (J.N.G.); (M.J.O.)
- BIO5 Institute, The University of Arizona, Tucson, AZ 85724, USA
- Department of Immunobiology, The University of Arizona, Tucson, AZ 85724, USA
- Department of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Marc J. Orbach
- Valley Fever Center for Excellence, The University of Arizona, Tucson, AZ 85724, USA; (L.F.S.); (D.A.P.); (J.N.G.); (M.J.O.)
- School of Plant Sciences, The University of Arizona, Tucson, AZ 85724, USA
| | | | - Yunro Chung
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Stacy A. Williams
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
| | - Vel Murugan
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
| | - Jin-gyoon Park
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
| | - Joshua LaBaer
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
| | - Douglas F. Lake
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA;
- Cactus Bio, LLC, Phoenix, AZ 85259, USA;
| | - D. Mitchell Magee
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA;
- Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (L.S.); (Y.C.); (S.A.W.); (V.M.); (J.-g.P.); (J.L.)
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13
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Eulálio KD, Kollath DR, Martins LMS, Filho ADD, Cavalcanti MDAS, Moreira LM, Tenório BG, Alves LGDB, Yamauchi D, Barrozo LV, Thompson Iii GR, Nacher M, Stajich JE, Benard G, Bagagli E, Felipe MSS, Barker BM, Trilles L, Teixeira MDM. Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil. Nat Commun 2024; 15:3190. [PMID: 38609393 PMCID: PMC11014852 DOI: 10.1038/s41467-024-47388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978-2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.
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Affiliation(s)
- Kelsen Dantas Eulálio
- Hospital de Doenças Infecto Contagiosas-HDIC, Federal University of Piauí-UFPI, Teresina, Piauí, Brazil
| | - Daniel R Kollath
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Antonio de Deus Filho
- Hospital de Doenças Infecto Contagiosas-HDIC, Federal University of Piauí-UFPI, Teresina, Piauí, Brazil
| | | | - Lucas Machado Moreira
- Evandro Chagas National Institute of Infectology, Fiocruz - RJ, Rio de Janeiro, Brazil
| | | | | | - Danielle Yamauchi
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
| | - Ligia Vizeu Barrozo
- Department of Geography, Faculty of Philosophy, Languages and Literature, and Human Sciences, University of São Paulo, São Paulo, Brazil
| | - George R Thompson Iii
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, UC-Davis, Sacramento, CA, USA
| | - Mathieu Nacher
- Centre d'Investigations Cliniques, INSERM 1424, Centre hospitalier de Cayenne - French Guiana, Cayenne, French Guiana
| | - Jason E Stajich
- Department of Microbiology and Plant Pathology University of California-Riverside, Riverside, CA, USA
| | - Gil Benard
- Laboratório de Micologia Medica, Departamento de Dermatologia, Instituto de Medicina Tropical, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
| | | | - Bridget M Barker
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Luciana Trilles
- Evandro Chagas National Institute of Infectology, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Marcus de Melo Teixeira
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA.
- Faculty of Medicine, University of Brasília, Brasília, Federal District, Brazil.
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14
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Lanks C. Fulminant Disseminated Coccidioidomycosis With Histoplasma Antigen Cross-Reactivity. Cureus 2024; 16:e58129. [PMID: 38738009 PMCID: PMC11088875 DOI: 10.7759/cureus.58129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
A 79-year-old man with type II diabetes mellitus and recently diagnosed idiopathic thrombocytopenic purpura presented to the Emergency Department with progressive dyspnea over the course of two weeks. He was found to have diffuse miliary nodules, dense cavitary consolidation, and widespread cystic changes on chest imaging and died within 48 hours of admission to the hospital. His serum Coccidioides antibody and urine Histoplasma antigen were both positive. He later grew Coccidioides immitis from the blood, supporting the theory that Histoplasma positivity was likely the result of antigen test cross-reactivity. Coccidioidomycosis typically presents with mild, self-limited symptoms, but may also disseminate rapidly, causing fulminant, life-threatening disease. Prompt recognition of risk factors for fulminant coccidioidomycosis and understanding flaws in serologic testing are essential to the appropriate diagnosis and management of this disease.
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Affiliation(s)
- Charles Lanks
- Pulmonary and Critical Care Medicine, Harbor University of California, Los Angeles Medical Center, Torrance, USA
- Respiratory Medicine, Lundquist Institute for Biomedical Innovation, Torrance, USA
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15
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Konkel Neabore L. Wake-up Call: Rapid Increase in Human Fungal Diseases under Climate Change. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:42001. [PMID: 38648197 PMCID: PMC11034633 DOI: 10.1289/ehp14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
Rising temperatures and extreme weather are setting the stage for increases in fungal diseases. As new pathogenic fungi emerge and known threats spread and evolve, scientists and decision makers are responding.
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16
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Kahn D, Chen W, Linden Y, Corbeil KA, Lowry S, Higham CA, Mendez KS, Burch P, DiFondi T, Verhougstraete M, De Roos AJ, Haas CN, Gerba C, Hamilton KA. A microbial risk assessor's guide to Valley Fever (Coccidioides spp.): Case study and review of risk factors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 917:170141. [PMID: 38242485 PMCID: PMC10923130 DOI: 10.1016/j.scitotenv.2024.170141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Valley Fever is a respiratory disease caused by inhalation of arthroconidia, a type of spore produced by fungi within the genus Coccidioides spp. which are found in dry, hot ecosystems of the Western Hemisphere. A quantitative microbial risk assessment (QMRA) for the disease has not yet been performed due to a lack of dose-response models and a scarcity of quantitative occurrence data from environmental samples. A literature review was performed to gather data on experimental animal dosing studies, environmental occurrence, human disease outbreaks, and meteorological associations. As a result, a risk framework is presented with information for parameterizing QMRA models for Coccidioides spp., with eight new dose-response models proposed. A probabilistic QMRA was conducted for a Southwestern US agricultural case study, evaluating eight scenarios related to farming occupational exposures. Median daily workday risks for developing severe Valley Fever ranged from 2.53 × 10-7 (planting by hand while wearing an N95 facemask) to 1.33 × 10-3 (machine harvesting while not wearing a facemask). The literature review and QMRA synthesis confirmed that exposure to aerosolized arthroconidia has the potential to result in high attack rates but highlighted that the mechanistic relationships between environmental conditions and disease remain poorly understood. Recommendations for Valley Fever risk assessment research needs in order to reduce disease risks are discussed, including interventions for farmers.
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Affiliation(s)
- David Kahn
- Department of Civil Architectural and Environmental Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - William Chen
- Department of Civil & Environmental Engineering & Earth Sciences, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karalee A Corbeil
- Department of Water Management and Hydrological Science, Texas A&M University, College Station, TX 79016, USA
| | - Sarah Lowry
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA 94305, USA
| | - Ciara A Higham
- Leeds Institute for Fluid Dynamics, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Karla S Mendez
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Paige Burch
- Seaford High School, 1575 Seamans Neck Rd, Seaford, NY 11783, USA
| | - Taylor DiFondi
- Seaford High School, 1575 Seamans Neck Rd, Seaford, NY 11783, USA
| | - Marc Verhougstraete
- University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Marton Ave., Tucson, AZ 85724, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Charles N Haas
- Department of Civil Architectural and Environmental Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - Charles Gerba
- University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Marton Ave., Tucson, AZ 85724, USA
| | - Kerry A Hamilton
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85281, USA.
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17
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Galgiani JN, Kauffman CA. Coccidioidomycosis and Histoplasmosis in Immunocompetent Persons. N Engl J Med 2024; 390:536-547. [PMID: 38324487 DOI: 10.1056/nejmra2306821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- John N Galgiani
- From the Valley Fever Center for Excellence, the Departments of Medicine and Immunobiology, College of Medicine-Tucson, and the BIO5 Institute, University of Arizona, Tucson (J.N.G.); and the Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (C.A.K.)
| | - Carol A Kauffman
- From the Valley Fever Center for Excellence, the Departments of Medicine and Immunobiology, College of Medicine-Tucson, and the BIO5 Institute, University of Arizona, Tucson (J.N.G.); and the Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (C.A.K.)
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18
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Money NP. Fungal thermotolerance revisited and why climate change is unlikely to be supercharging pathogenic fungi (yet). Fungal Biol 2024; 128:1638-1641. [PMID: 38341269 DOI: 10.1016/j.funbio.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Thermotolerance has been viewed as an uncommon characteristic among the fungi and one of the reasons that less than 1% of the described species operate as opportunistic pathogens of humans. Growth at 37°C is certainly a requirement for a fungus that invades the body core, but tens of thousands of nonpathogenic species are also able to grow at this temperature. Ergo, body temperature does not serve as a thermal barrier to the development of infections by many harmless fungi. The absence of other virulence factors must be more demanding. This observation raises questions about the hypothetical links between climate change and the increasing number of life-threatening human mycoses. Given the widespread distribution of fungal thermotolerance and the 1°C (2°F) increase in global temperature over the last 140 years it seems unlikely that the warming climate has driven the evolution of more virulent strains of fungi. More compelling explanations for the changes in the behavior of fungi as disease agents include their adaptation to the widening use of azole antifungals in hospitals and the wholesale application of millions of tons of the same class of heterocyclic chemicals in agriculture. On the other hand, climate change is having a significant effect on the spread of human mycoses by extending the geographical range of pathogenic fungi. A related increase in fungal asthma caused by spore inhalation is another likely consequence of planetary change.
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Affiliation(s)
- Nicholas P Money
- Western Program and Department of Biology, Miami University, Oxford, OH, 45056, USA.
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19
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Burnham-Marusich AR, Zayac KR, Galgiani JN, Lewis L, Kozel TR. Antigenic Relatedness between Mannans from Coccidioides immitis and Coccidioides posadasii Spherules and Mycelia. J Fungi (Basel) 2024; 10:89. [PMID: 38392761 PMCID: PMC10890221 DOI: 10.3390/jof10020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Immunoassays for cell wall mannans that are excreted into serum and urine have been used as an aid in the diagnosis of many disseminated fungal infections, including coccidioidomycosis. Antigen-detection immunoassays are critically dependent on the detection of an analyte, such as mannan, by antibodies that are specific to the analyte. The goal of this study was to evaluate the extent of cross-reactivity of polyclonal antibodies raised against Coccidioides spp. Analysis of antigenic relatedness between mannans from C. posadasii and C. immitis spherules and mycelia showed complete relatedness when evaluated by the method of Archetti and Horsfall, which was originally used to study the antigenic relationships between Influenzae virus isolates. In a further effort to validate the suitability of the antigenic relatedness calculation methodology for polysaccharide antigens, we also applied the method of Archetti and Horsfall to published results that had previously identified the major capsular serotypes of Cryptococcus species. The results of this analysis showed that Archetti and Horsfall's antigenic relatedness calculation correctly identified the major cryptococcal serotypes. Together, these results suggest that the method is applicable to polysaccharide antigens, and that immunoassays that detect Coccidioides mannans are likely to have good reactivity across Coccidioides species (inclusivity) due to the species' high level of antigenic relatedness.
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Affiliation(s)
| | - Kathleen R. Zayac
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, NV 89557, USA; (K.R.Z.); (T.R.K.)
| | - John N. Galgiani
- Valley Fever Center for Excellence, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA; (J.N.G.); (L.L.)
- Department of Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA
- Department of Immunobiology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Lourdes Lewis
- Valley Fever Center for Excellence, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA; (J.N.G.); (L.L.)
| | - Thomas R. Kozel
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, NV 89557, USA; (K.R.Z.); (T.R.K.)
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20
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Bryan AW, Sykes J, Crucillo K, Zhang K, Bays DJ, Cohen SH, Wilson MD, Thompson GR. Comparison of coccidioidal complement fixation and quantitative immunodiffusion serology at a reference laboratory. Med Mycol 2024; 62:myad121. [PMID: 38061838 DOI: 10.1093/mmy/myad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The incidence of coccidioidomycosis continues to increase. The diagnosis frequently relies on non-invasive diagnostic testing with immunodiffusion and complement fixation (CF) testing the current gold standard. A direct comparison of quantitative immunodiffusion and CF for IgG antibodies has not been previously reported. In a comparison of 368 samples, there was close concordance observed (360/368 = 97.8%) (P-value < .001). These tests can be considerably interchangeable in the reference laboratory setting.
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Affiliation(s)
- Allen W Bryan
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Jane Sykes
- University of California, Davis, School of Veterinary Medicine, Davis, CA, USA
| | - Kelly Crucillo
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Kaihua Zhang
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Derek J Bays
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Stuart H Cohen
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Machelle D Wilson
- University of California, Davis, Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center, Sacramento, CA, USA
| | - George R Thompson
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
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21
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Ferguson AJ, Thompson GR, Bruyette D, Sykes JE. The dog as a sentinel and animal model for coccidioidomycosis. Med Mycol 2024; 62:myad139. [PMID: 38148116 DOI: 10.1093/mmy/myad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 12/28/2023] Open
Abstract
Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change-along with predicted population increases and increased development in the southwest United States-may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.
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Affiliation(s)
- Adam J Ferguson
- Department of Biological Sciences, University of California-San Diego, La Jolla, USA
| | - George R Thompson
- Department of Internal Medicine - Division of Infectious Diseases, University of California-Davis, Davis, USA
| | | | - Jane E Sykes
- Department of Medicine & Epidemiology, University of California-Davis, Davis, USA
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22
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Harris HS, Harris MD, Thompson GR, Engelthaler DM, Montfort PL, Leviner AL, Miller MA. Novel Presentation of Coccidioidomycosis with Myriad Free-Floating Proteinaceous Spheres in the Pericardial Sac of a Southern Sea Otter (Enhydra lutris nereis). J Wildl Dis 2024; 60:223-228. [PMID: 37756694 DOI: 10.7589/jwd-d-23-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/26/2023] [Indexed: 09/29/2023]
Abstract
A southern sea otter (Enhydra lutris nereis) stranded dead in central California, USA, with a distended pericardial sac containing thousands of free-floating proteinaceous masses. Serology, fungal culture, PCR, and sequencing confirmed the etiology of this novel lesion as Coccidioides immitis. Range expansion of this zoonotic pathogen is predicted with climate change.
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Affiliation(s)
- Heather S Harris
- The Marine Mammal Center, 1385 Main Street, Morro Bay, California 93442, USA
- California Polytechnic State University, Animal Science Department, 1 Grand Avenue, San Luis Obispo, California 93407, USA
| | - Michael D Harris
- California Department of Fish and Wildlife, Marine Wildlife Veterinary Care and Research Center, 151 McAllister Way, Santa Cruz, California 95060, USA
| | - George R Thompson
- University of California Davis Medical Center, Department of Internal Medicine, Division of Infectious Diseases, 4150 V Street, Suite G500, Sacramento, California 95817, USA
| | - David M Engelthaler
- Translational Genomics Research Institute, Pathogen and Microbiome Division, 3051 W Shamrell Boulevard, Flagstaff, Arizona 86005, USA
| | - Parker L Montfort
- Translational Genomics Research Institute, Pathogen and Microbiome Division, 3051 W Shamrell Boulevard, Flagstaff, Arizona 86005, USA
| | - Alexis L Leviner
- California Polytechnic State University, Animal Science Department, 1 Grand Avenue, San Luis Obispo, California 93407, USA
| | - Melissa A Miller
- California Department of Fish and Wildlife, Marine Wildlife Veterinary Care and Research Center, 151 McAllister Way, Santa Cruz, California 95060, USA
- University of California Davis Wildlife Health Center, 1089 Veterinary Medicine Drive, Davis, California 95616, USA
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23
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Krogstad P, Thompson GR, Heidari A, Kuran R, Stephens AV, Butte MJ, Johnson R. A Clinicopathological Categorization System for Clinical Research in Coccidioidomycosis. Open Forum Infect Dis 2023; 10:ofad597. [PMID: 38156047 PMCID: PMC10753911 DOI: 10.1093/ofid/ofad597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
A wide array of clinical manifestations follow infection with Coccidioides immitis or Coccidioides posadasii, ranging from asymptomatic infection to life-threatening pulmonary disease or extrapulmonary dissemination and meningitis. Epidemiological studies require consistent definitions of cases and their comparative clinical features. Understanding host and pathogen determinants of the severity of coccidioidomycosis also requires that specific clinical features (such as coccidioidal meningitis) and their overlap be precisely defined and quantified. Here we propose a system for categorization of outcomes of coccidioidomycosis in individuals who are not overtly immunocompromised that harmonizes clinical assessments during translational research of this increasingly common disease.
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Affiliation(s)
- Paul Krogstad
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - George R Thompson
- Division of Infectious Diseases, UC Davis School of Medicine, Sacramento California, USA
| | - Arash Heidari
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Dignity Health, Bakersfield Memorial Hospital, Bakersfield, California, USA
| | - Rasha Kuran
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine, Kern Medical, Bakersfield, California, USA
| | - Alexis V Stephens
- Institute of Precision Health, University of California, Los Angeles, California, USA
| | - Manish J Butte
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Royce Johnson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine, Kern Medical, Bakersfield, California, USA
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24
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Kaplan SR, Rajagopal A, Cachay ER, Deiss R. A case of disseminated coccidioidomycosis and immune reconstitution inflammatory syndrome (IRIS) in a patient with HIV/AIDS. IDCases 2023; 34:e01896. [PMID: 37727860 PMCID: PMC10506086 DOI: 10.1016/j.idcr.2023.e01896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
Coccidioidomycosis is a fungal infection endemic to the southwestern United States and Central/South America, and its range is expanding with the warming climate. People with HIV/AIDS are at increased risk of developing disseminated infection, and furthermore are at risk for developing immune reconstitution inflammatory syndrome (IRIS) if they are initiating or re-initiating anti-retroviral therapy (ART). There have been few cases of coccidioidomycosis-related IRIS reported in the literature, and there is no clear guidance on treatment. We present a case of paradoxical IRIS in a patient with AIDS who clinically improved after initiating corticosteroids.
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Affiliation(s)
- Samantha R. Kaplan
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Amutha Rajagopal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Edward R. Cachay
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Robert Deiss
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
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25
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Ticknor I, Cadavona JJ, Roby KD, Cotter DG. Disseminated cutaneous coccidioidomycosis masquerading as acne keloidalis nuchae. JAAD Case Rep 2023; 39:64-66. [PMID: 37635857 PMCID: PMC10448317 DOI: 10.1016/j.jdcr.2023.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Iesha Ticknor
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - John Jay Cadavona
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Keith D. Roby
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Dermatology, University of California, San Diego, San Diego, California
- Department of Dermatology, Southern California Permanente Medical Group, San Diego, California
| | - David G. Cotter
- Kirk Kekorian School of Medicine at UNLV, Las Vegas, Nevada
- Las Vegas Dermatology, Las Vegas, Nevada
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26
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Smith DFQ, Casadevall A. Disaster mycology. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:267-277. [PMID: 37721902 PMCID: PMC10599715 DOI: 10.7705/biomedica.6943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 09/20/2023]
Abstract
Natural and human-made disasters have long played a role in shaping the environment and microbial communities, also affecting non-microbial life on Earth. Disaster microbiology is a new concept based on the notion that a disaster changes the environment causing adaptation or alteration of microbial populations -growth, death, transportation to a new area, development traits, or resistance- that can have downstream effects on the affected ecosystem. Such downstream effects include blooms of microbial populations and the ability to colonize a new niche or host, cause disease, or survive in former extreme conditions. Throughout history, fungal populations have been affected by disasters. There are prehistoric archeological records of fungal blooms after asteroid impacts and fungi implicated in the fall of the dinosaurs. In recent times, drought and dust storms have caused disturbance of soil fungi, and hurricanes have induced the growth of molds on wet surfaces, resulting in an increased incidence of fungal disease. Probably, the anticipated increase in extreme heat would force fungi adaptation to survive at high temperatures, like those in the human body, and thus be able to infect mammals. This may lead to a drastic rise of new fungal diseases in humans.
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Affiliation(s)
- Daniel F Q Smith
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.
| | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.
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27
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Schwartz IS, Marek C, Sandhu H, Abdelmonem A, Petersen G, Dishner E, Heidari A, Thompson GR. Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis. Emerg Infect Dis 2023; 29:1297-1301. [PMID: 37347877 PMCID: PMC10310367 DOI: 10.3201/eid2907.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.
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28
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Miranda N, Hoyer KK. Coccidioidomycosis Granulomas Informed by Other Diseases: Advancements, Gaps, and Challenges. J Fungi (Basel) 2023; 9:650. [PMID: 37367586 DOI: 10.3390/jof9060650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Valley fever is a respiratory disease caused by a soil fungus, Coccidioides, that is inhaled upon soil disruption. One mechanism by which the host immune system attempts to control and eliminate Coccidioides is through granuloma formation. However, very little is known about granulomas during Coccidioides infection. Granulomas were first identified in tuberculosis (TB) lungs as early as 1679, and yet many gaps in our understanding of granuloma formation, maintenance, and regulation remain. Granulomas are best defined in TB, providing clues that may be leveraged to understand Coccidioides infections. Granulomas also form during several other infectious and spontaneous diseases including sarcoidosis, chronic granulomatous disease (CGD), and others. This review explores our current understanding of granulomas, as well as potential mechanisms, and applies this knowledge to unraveling coccidioidomycosis granulomas.
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Affiliation(s)
- Nadia Miranda
- Quantitative Systems Biology Graduate Program, University of California Merced, Merced, CA 95343, USA
| | - Katrina K Hoyer
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA 95343, USA
- Health Sciences Research Institute, University of California Merced, Merced, CA 95343, USA
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29
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Parsons MG, Diekema DJ. What Is New in Fungal Infections? Mod Pathol 2023; 36:100187. [PMID: 37059227 DOI: 10.1016/j.modpat.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/11/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Invasive fungal infections are an increasingly important cause of morbidity and mortality. We provide a summary of important changes in the epidemiology of invasive fungal infections, citing examples of new emerging pathogens, expanding populations who are at-risk, and increasing antifungal resistance. We review how human activity and climate change may play a role in some of these changes. Finally, we discuss how these changes create the need for advances in fungal diagnostics. The limitations of existing fungal diagnostic testing emphasize the critically important role of histopathology in the early recognition of fungal disease.
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Affiliation(s)
- Meredith G Parsons
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel J Diekema
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department and Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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30
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Peterson MW, Jain R, Hildebrandt K, Carson WK, Fayed MA. Differentiating Lung Nodules Due to Coccidioides from Those Due to Lung Cancer Based on Radiographic Appearance. J Fungi (Basel) 2023; 9:641. [PMID: 37367577 DOI: 10.3390/jof9060641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Coccidioidomycosis (cocci) is an endemic fungal disease that can cause asymptomatic or post-symptomatic lung nodules which are visible on chest CT scanning. Lung nodules are common and can represent early lung cancer. Differentiating lung nodules due to cocci from those due to lung cancer can be difficult and lead to invasive and expensive evaluations. MATERIALS AND METHODS We identified 302 patients with biopsy-proven cocci or bronchogenic carcinoma seen in our multidisciplinary nodule clinic. Two experienced radiologists who were blinded to the diagnosis read the chest CT scans and identified radiographic characteristics to determine their utility in differentiating lung cancer nodules from those due to cocci. RESULTS Using univariate analysis, we identified several radiographic findings that differed between lung cancer and cocci infection. We then entered these variables along with age and gender into a multivariate model and found that age, nodule diameter, nodule cavitation, presence of satellite nodules and radiographic presence of chronic lung disease differed significantly between the two diagnoses. Three findings, cavitary nodules, satellite nodules and chronic lung disease, have sufficient discrimination to potentially be useful in clinical decision-making. CONCLUSIONS Careful evaluation of the three obtained radiographic findings can significantly improve our ability to differentiate benign coccidioidomycosis infection from lung cancer in an endemic region for the fungal disease. Using these data may significantly reduce the cost and risk associated with distinguishing the cause of lung nodules in these patients by preventing unnecessary invasive studies.
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Affiliation(s)
- Michael W Peterson
- Fresno Department of Medicine, University of California (San Francisco), San Francisco, CA 93701, USA
- UCSF Fresno/Community Medical Centers' Multidisciplinary Lung Nodule Clinic, Fresno, CA 93701, USA
| | - Ratnali Jain
- Fresno Department of Medicine, University of California (San Francisco), San Francisco, CA 93701, USA
| | - Kurt Hildebrandt
- Community Medical Imaging Radiology Group, Fresno, CA 93721, USA
| | | | - Mohamed A Fayed
- Fresno Department of Medicine, University of California (San Francisco), San Francisco, CA 93701, USA
- UCSF Fresno/Community Medical Centers' Multidisciplinary Lung Nodule Clinic, Fresno, CA 93701, USA
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31
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Laux K, Teixeira MDM, Barker B. Love in the time of climate change: A review of sexual reproduction in the order Onygenales. Fungal Genet Biol 2023; 167:103797. [PMID: 37100376 DOI: 10.1016/j.fgb.2023.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
Life-threatening infections caused by fungi in the order Onygenales have been rising over the last few decades. Increasing global temperature due to anthropogenic climate change is one potential abiotic selection pressure that may explain the increase in infections. The generation of genetically novel offspring with novel phenotypes through the process of sexual recombination could allow fungi to adapt to changing climate conditions. The basic structures associated with sexual reproduction have been identified in Histoplasma, Blastomyces, Malbranchea, and Brunneospora. However, for Coccidioides and Paracoccidioides, the actual structural identification of these processes has yet to be identified despite having genetic evidence that suggests sexual recombination is occurring in these organisms. This review highlights the importance of assessing sexual recombination in the order Onygenales as a means of understanding the mechanisms these organisms might employ to enhance fitness in the face of a changing climate and provides details regarding the known reproductive mechanisms in the Onygenales.
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Affiliation(s)
- Klaire Laux
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA.
| | - Marcus de Melo Teixeira
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA; Nùcleo de Medicina Tropical, University of Brasilia, Universitário Darcy Ribeiro, s/n -Asa Norte, Brasília, DF 70910-900, Brazil
| | - Bridget Barker
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA.
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32
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McHardy IH, Barker B, Thompson GR. Review of Clinical and Laboratory Diagnostics for Coccidioidomycosis. J Clin Microbiol 2023; 61:e0158122. [PMID: 36883820 PMCID: PMC10204634 DOI: 10.1128/jcm.01581-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Coccidioidomycosis is a fungal disease associated with soil exposure that frequently goes undiagnosed due at least in part to its nonspecific presentation and the lack of clinical suspicion by health care providers. Currently available diagnostics for coccidioidomycosis offer qualitative results that can suffer from low specificity, while semiquantitative assays are labor-intensive and complex and can require multiple days to complete. Furthermore, significant confusion exists regarding the optimal diagnostic algorithms and appropriate usage of available diagnostic tests. This review aims to inform clinical laboratorians and treating clinicians about the current diagnostic landscape, appropriate diagnostic strategies, and future diagnostic directions for coccidioidomycosis, which is expected to become more prevalent due to increased migration into areas of endemicity and climate changes.
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Affiliation(s)
- Ian H. McHardy
- Scripps Medical Laboratory, Scripps Health, San Diego, California, USA
- University of California, Davis Center for Valley Fever, Sacramento, California, USA
| | - Bridget Barker
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, California, USA
- University of California, Davis Center for Valley Fever, Sacramento, California, USA
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33
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Tejeda-Garibay S, Hoyer KK. Coccidioidomycosis and Host Microbiome Interactions: What We Know and What We Can Infer from Other Respiratory Infections. J Fungi (Basel) 2023; 9:586. [PMID: 37233297 PMCID: PMC10219296 DOI: 10.3390/jof9050586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Between 70 and 80% of Valley fever patients receive one or more rounds of antibiotic treatment prior to accurate diagnosis with coccidioidomycosis. Antibiotic treatment and infection (bacterial, viral, fungal, parasitic) often have negative implications on host microbial dysbiosis, immunological responses, and disease outcome. These perturbations have focused on the impact of gut dysbiosis on pulmonary disease instead of the implications of direct lung dysbiosis. However, recent work highlights a need to establish the direct effects of the lung microbiota on infection outcome. Cystic fibrosis, chronic obstructive pulmonary disease, COVID-19, and M. tuberculosis studies suggest that surveying the lung microbiota composition can serve as a predictive factor of disease severity and could inform treatment options. In addition to traditional treatment options, probiotics can reverse perturbation-induced repercussions on disease outcomes. The purpose of this review is to speculate on the effects perturbations of the host microbiome can have on coccidioidomycosis progression. To do this, parallels are drawn to aa compilation of other host microbiome infection studies.
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Affiliation(s)
- Susana Tejeda-Garibay
- Quantitative and Systems Biology, Graduate Program, University of California Merced, Merced, CA 95343, USA
| | - Katrina K. Hoyer
- Department of Molecular and Cell Biology, University California Merced, Merced, CA 95343, USA
- Health Sciences Research Institute, University of California Merced, Merced, CA 95343, USA
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34
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Schulte PA, Jacklitsch BL, Bhattacharya A, Chun H, Edwards N, Elliott KC, Flynn MA, Guerin R, Hodson L, Lincoln JM, MacMahon KL, Pendergrass S, Siven J, Vietas J. Updated assessment of occupational safety and health hazards of climate change. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:183-206. [PMID: 37104117 PMCID: PMC10443088 DOI: 10.1080/15459624.2023.2205468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.
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Affiliation(s)
- P. A. Schulte
- Advanced Technologies and Laboratories International, Inc, Cincinnati, Ohio
| | - B. L. Jacklitsch
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - A. Bhattacharya
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - H. Chun
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia
| | - N. Edwards
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
| | - K. C. Elliott
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Anchorage, Alaska
| | - M. A. Flynn
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - R. Guerin
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - L. Hodson
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) (retired), Cincinnati, Ohio
| | - J. M. Lincoln
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - K. L. MacMahon
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - S. Pendergrass
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) (retired), Cincinnati, Ohio
| | - J. Siven
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - J. Vietas
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
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35
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Zangeneh TT, Al-Obaidi MM. Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients. J Fungi (Basel) 2023; 9:jof9050513. [PMID: 37233224 DOI: 10.3390/jof9050513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Coccidioidomycosis is a fungal infection endemic in the southwestern United States, Mexico, and parts of Central and South America. While coccidioidomycosis is associated with mostly mild infections in the general population, it can lead to devastating infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Early and accurate diagnosis is important in achieving better clinical outcomes in immunocompromised patients. However, the diagnosis of coccidioidomycosis in SOT recipients can be challenging due to the limitations of diagnostic methods including cultures, serology, and other tests in providing a timely and accurate diagnosis. In this review, we will discuss the available diagnostic modalities and approaches when evaluating SOT recipients with coccidioidomycosis, from the use of conventional culture methods to serologic and molecular testing. Additionally, we will discuss the role of early diagnosis in assisting with the administration of effective antifungal therapy to reduce infectious complications. Finally, we will discuss ways to improve the performance of coccidioidomycosis diagnostic methods in SOT recipients with an option for a combined testing approach.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, College of Medicine, University of Arizona, 1501 N Campbell Avenue, P.O. Box 245022, Tucson, AZ 85724, USA
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, College of Medicine, University of Arizona, 1501 N Campbell Avenue, P.O. Box 245022, Tucson, AZ 85724, USA
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36
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Mazi PB, Sahrmann JM, Olsen MA, Coler-Reilly A, Rauseo AM, Pullen M, Zuniga-Moya JC, Powderly WG, Spec A. The Geographic Distribution of Dimorphic Mycoses in the United States for the Modern Era. Clin Infect Dis 2023; 76:1295-1301. [PMID: 36366776 PMCID: PMC10319749 DOI: 10.1093/cid/ciac882] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The dimorphic mycoses (DMs) of the United States-Histoplasma, Coccidioides, and Blastomyces-commonly known as endemic mycoses of North America (in addition to Paracoccidioides) are increasingly being diagnosed outside their historical areas of endemicity. Despite this trend, the maps outlining their geographic distributions have not been updated in more than half a century using a large, nationwide database containing individual-patient-level data. METHODS This was a retrospective analysis of >45 million Medicare fee-for-service beneficiaries from 1 January 2007 through 31 December 2016. Diagnoses of histoplasmosis, coccidioidomycosis, and blastomycosis were defined by International Classification of Diseases, Ninth/10th Revision, codes. The primary outcome was the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis for each US county. Clinically meaningful thresholds for incidence were defined as 100 cases/100 000 person-years for histoplasmosis and coccidioidomycosis and 50 cases/100 000 person-years for blastomycosis. RESULTS There were 79 749 histoplasmosis, 37 726 coccidioidomycosis, and 6109 blastomycosis diagnoses in unique persons from 2007-2016 across 3143 US counties. Considering all US states plus Washington, DC, 94% (48/51) had ≥1 county above the clinically relevant threshold for histoplasmosis, 69% (35/51) for coccidioidomycosis, and 78% (40/51) for blastomycosis. CONCLUSIONS Persons with histoplasmosis, coccidioidomycosis, and blastomycosis are diagnosed in significant numbers outside their historical geographic distributions established >50 years ago. Clinicians should consider DM diagnoses based on compatible clinical syndromes with less emphasis placed on patients' geographic exposure. Increased clinical suspicion leading to a subsequent increase in DM diagnostic testing would likely result in fewer missed diagnoses, fewer diagnostic delays, and improved patient outcomes.
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Affiliation(s)
- Patrick B Mazi
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - John M Sahrmann
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ariella Coler-Reilly
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Matthew Pullen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julio C Zuniga-Moya
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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Abstract
Coccidioides immitis, a pathogenic environmental fungus that causes Valley fever (coccidioidomycosis) primarily in the American Southwest and parts of Central and South America, has emerged over the past 12 years in the Columbia River Basin region, near the confluence with the Yakima River, in southcentral Washington state, USA. An initial autochthonous Washington human case was found in 2010, stemming from a wound derived from soil contamination during an all-terrain vehicle crash. Subsequent analysis identified multiple positive soil samples from the park where the crash occurred (near the Columbia River in Kennewick, WA), and from another riverside location several kilometers upstream from the park location. Intensified disease surveillance identified several more cases of coccidioidomycosis in the region that lacked any relevant travel history to known endemic locales. Genomic analysis of both patient and soil isolates from the Washington cases determined that all samples from the region are phylogenetically closely related. Given the genomic and the epidemiological link between case and environment, C. immitis was declared to be a newly endemic fungus in the region, spawning many questions as to the scope of its presence, the causes of its recent emergence, and what it predicts about the changing landscape of this disease. Here, we review this discovery through a paleo-epidemiological lens in the context of what is known about C. immitis biology and pathogenesis and propose a novel hypothesis for the cause of the emergence in southcentral Washington. We also try to place it in the context of our evolving understanding of this regionally specific pathogenic fungus.
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Microbiology and Climate Change: a Transdisciplinary Imperative. mBio 2023; 14:e0333522. [PMID: 36723077 PMCID: PMC9973284 DOI: 10.1128/mbio.03335-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Climate change is a complex problem involving nonlinearities and feedback that operate across scales. No single discipline or way of thinking can effectively address the climate crisis. Teams of natural scientists, social scientists, engineers, economists, and policymakers must work together to understand, predict, and mitigate the rapidly accelerating impacts of climate change. Transdisciplinary approaches are urgently needed to address the role that microorganisms play in climate change. Here, we demonstrate with case studies how diverse teams and perspectives provide climate-change insight related to the range expansion of emerging fungal pathogens, technological solutions for harmful cyanobacterial blooms, and the prediction of disease-causing microorganisms and their vector populations using massive networks of monitoring stations. To serve as valuable members of a transdisciplinary climate research team, microbiologists must reach beyond the boundaries of their immediate areas of scientific expertise and engage in efforts to build open-minded teams aimed at scalable technologies and adoptable policies.
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Yeh KB, Parekh FK, Mombo I, Leimer J, Hewson R, Olinger G, Fair JM, Sun Y, Hay J. Climate change and infectious disease: A prologue on multidisciplinary cooperation and predictive analytics. Front Public Health 2023; 11:1018293. [PMID: 36741948 PMCID: PMC9895942 DOI: 10.3389/fpubh.2023.1018293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
Climate change impacts global ecosystems at the interface of infectious disease agents and hosts and vectors for animals, humans, and plants. The climate is changing, and the impacts are complex, with multifaceted effects. In addition to connecting climate change and infectious diseases, we aim to draw attention to the challenges of working across multiple disciplines. Doing this requires concentrated efforts in a variety of areas to advance the technological state of the art and at the same time implement ideas and explain to the everyday citizen what is happening. The world's experience with COVID-19 has revealed many gaps in our past approaches to anticipating emerging infectious diseases. Most approaches to predicting outbreaks and identifying emerging microbes of major consequence have been with those causing high morbidity and mortality in humans and animals. These lagging indicators offer limited ability to prevent disease spillover and amplifications in new hosts. Leading indicators and novel approaches are more valuable and now feasible, with multidisciplinary approaches also within our grasp to provide links to disease predictions through holistic monitoring of micro and macro ecological changes. In this commentary, we describe niches for climate change and infectious diseases as well as overarching themes for the important role of collaborative team science, predictive analytics, and biosecurity. With a multidisciplinary cooperative "all call," we can enhance our ability to engage and resolve current and emerging problems.
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Affiliation(s)
| | | | - Illich Mombo
- CIRMF, Franceville, Gabon, Central African Republic
| | | | - Roger Hewson
- UK Health Security Agency, Salisbury, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Jeanne M. Fair
- Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Yijun Sun
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - John Hay
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
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Gharakhanian R, Ohno A, Craig D, Wang S. Valley fever, mimicker of malignancy. Heliyon 2023; 9:e12900. [PMID: 36685442 PMCID: PMC9851880 DOI: 10.1016/j.heliyon.2023.e12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Coccidioidomycosis rates in endemic areas such as California and Arizona have been increasing in recent years. Most common manifestations in symptomatic individuals involve the lungs. Disseminated disease occurs when the infection spreads beyond the lungs. Disseminated disease occurs in about 1% of all coccidiomycosis cases. Diagnosis in classically non-endemic regions can be difficult as coccidiomycosis can mimic a variety of other illnesses which can lead to delays in initiating appropriate therapy. We report a case of severe disseminated coccidiomycosis involving the soft tissue, bone, and intra-abdominal organs in a previously healthy individual that was initially thought to be a malignancy. With climate change possibly altering the traditional endemic regions and expanding Coccidioides to new territories, this case reinforces the importance of maintaining a broad differential as well as awareness of disease manifestations for healthcare providers who do not regularly treat Coccidioides.
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Affiliation(s)
- Raffi Gharakhanian
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA,Corresponding author.
| | - Ai Ohno
- California University of Science and Medicine School of Medicine, 1501 Violet St., Colton, CA 92324, USA
| | - Debra Craig
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA,California University of Science and Medicine School of Medicine, 1501 Violet St., Colton, CA 92324, USA
| | - Sharon Wang
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA
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Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America. J Fungi (Basel) 2023; 9:jof9010083. [PMID: 36675904 PMCID: PMC9863933 DOI: 10.3390/jof9010083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
Coccidioidomycosis (Valley fever) has been a known health threat in the United States (US) since the 1930s, though not all states are currently required to report disease cases. Texas, one of the non-reporting states, is an example of where both historical and contemporary scientific evidence define the region as endemic, but we don't know disease incidence in the state. Mandating coccidioidomycosis as a reportable disease across more US states would increase disease awareness, improve clinical outcomes, and help antifungal drug and vaccine development. It would also increase our understanding of where the disease is endemic and the relationships between environmental conditions and disease cases. This is true for other nations in North and South America that are also likely endemic for coccidioidomycosis, especially Mexico. This commentary advocates for US state and territory epidemiologists to define coccidioidomycosis as a reportable disease and encourages disease surveillance in other endemic regions across North and South America in order to protect human health and reduce disease burden.
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Monroy-Nieto J, Gade L, Benedict K, Etienne KA, Litvintseva AP, Bowers JR, Engelthaler DM, Chow NA. Genomic Epidemiology Linking Nonendemic Coccidioidomycosis to Travel. Emerg Infect Dis 2023; 29:110-117. [PMID: 36573555 PMCID: PMC9796224 DOI: 10.3201/eid2901.220771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Coccidioidomycosis is a fungal infection endemic to hot, arid regions of the western United States, northern Mexico, and parts of Central and South America. Sporadic cases outside these regions are likely travel-associated; alternatively, an infection could be acquired in as-yet unidentified newly endemic locales. A previous study of cases in nonendemic regions with patient self-reported travel history suggested that infections were acquired during travel to endemic regions. We sequenced 19 Coccidioides isolates from patients with known travel histories from that earlier investigation and performed phylogenetic analysis to identify the locations of potential source populations. Our results show that those isolates were phylogenetically linked to Coccidioides subpopulations naturally occurring in 1 of the reported travel locales, confirming that these cases were likely acquired during travel to endemic regions. Our findings demonstrate that genomic analysis is a useful tool for investigating travel-related coccidioidomycosis.
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Head JR, Sondermeyer-Cooksey G, Heaney AK, Yu AT, Jones I, Bhattachan A, Campo SK, Wagner R, Mgbara W, Phillips S, Keeney N, Taylor J, Eisen E, Lettenmaier DP, Hubbard A, Okin GS, Vugia DJ, Jain S, Remais JV. Effects of precipitation, heat, and drought on incidence and expansion of coccidioidomycosis in western USA: a longitudinal surveillance study. Lancet Planet Health 2022; 6:e793-e803. [PMID: 36208642 PMCID: PMC10189771 DOI: 10.1016/s2542-5196(22)00202-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Drought is an understudied driver of infectious disease dynamics. Amidst the ongoing southwestern North American megadrought, California (USA) is having the driest multi-decadal period since 800 CE, exacerbated by anthropogenic warming. In this study, we aimed to examine the influence of drought on coccidioidomycosis, an emerging infectious disease in southwestern USA. METHODS We analysed California census tract-level surveillance data from 2000 to 2020 using generalised additive models and distributed monthly lags on precipitation and temperature. We then developed an ensemble prediction algorithm of incident cases of coccidioidomycosis per census tract to estimate the counterfactual incidence that would have occurred in the absence of drought. FINDINGS Between April 1, 2000, and March 31, 2020, there were 81 448 reported cases of coccidioidomycosis throughout California. An estimated 1467 excess cases of coccidioidomycosis were observed in California in the 2 years following the drought that occurred between 2007 and 2009, and an excess 2649 drought-attributable cases of coccidioidomycosis were observed in the 2 years following the drought that occurred between 2012 and 2015. These increased numbers of cases more than offset the declines in cases that occurred during drought. An IQR increase in summer temperatures was associated with 2·02 (95% CI 1·84-2·22) times higher incidence in the following autumn (September to November), and an IQR increase in precipitation in the winter was associated with 1·45 (1·36-1·55) times higher incidence in the autumn. The effect of winter precipitation was 36% (25-48) stronger when preceded by two dry, rather than average, winters. Incidence in arid counties was most sensitive to precipitation fluctuations, while incidence in wetter counties was most sensitive to temperature. INTERPRETATION In California, multi-year cycles of dry conditions followed by a wet winter increases transmission of coccidioidomycosis, especially in historically wetter areas. With anticipated increasing frequency of drought in southwestern USA, continued expansion of coccidioidomycosis, along with more intense seasons, is expected. Our results motivate the need for heightened precautions against coccidioidomycosis in seasons that follow major droughts. FUNDING National Institutes of Health.
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Affiliation(s)
- Jennifer R Head
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA; Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | | | - Alexandra K Heaney
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Alexander T Yu
- Infectious Disease Branch, California Department of Public Health, Richmond, CA, USA
| | - Isabel Jones
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | | | - Simon K Campo
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Robert Wagner
- Department of Plant and Microbial Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Whitney Mgbara
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, Berkeley, CA, USA
| | - Sophie Phillips
- College of Letters and Science, University of California, Berkeley, Berkeley, CA, USA
| | - Nicole Keeney
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - John Taylor
- Department of Plant and Microbial Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Ellen Eisen
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA
| | | | - Alan Hubbard
- Division of Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Gregory S Okin
- Department of Geography, University of California, Berkeley, Berkeley, CA, USA
| | - Duc J Vugia
- Infectious Disease Branch, California Department of Public Health, Richmond, CA, USA
| | - Seema Jain
- Infectious Disease Branch, California Department of Public Health, Richmond, CA, USA
| | - Justin V Remais
- Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA, USA.
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Salazar-Hamm PS, Montoya KN, Montoya L, Cook K, Liphardt S, Taylor JW, Cook JA, Natvig DO. Breathing can be dangerous: Opportunistic fungal pathogens and the diverse community of the small mammal lung mycobiome. FRONTIERS IN FUNGAL BIOLOGY 2022; 3:996574. [PMID: 37746221 PMCID: PMC10512277 DOI: 10.3389/ffunb.2022.996574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/24/2022] [Indexed: 09/26/2023]
Abstract
Human lung mycobiome studies typically sample bronchoalveolar lavage or sputum, potentially overlooking fungi embedded in tissues. Employing ultra-frozen lung tissues from biorepositories, we obtained fungal ribosomal RNA ITS2 sequences from 199 small mammals across 39 species. We documented diverse fungi, including common environmental fungi such as Penicillium and Aspergillus, associates of the human mycobiome such as Malassezia and Candida, and others specifically adapted for lungs (Coccidioides, Blastomyces, and Pneumocystis). Pneumocystis sequences were detected in 83% of the samples and generally exhibited phylogenetic congruence with hosts. Among sequences from diverse opportunistic pathogens in the Onygenales, species of Coccidioides occurred in 12% of samples and species of Blastomyces in 85% of samples. Coccidioides sequences occurred in 14 mammalian species. The presence of neither Coccidioides nor Aspergillus fumigatus correlated with substantial shifts in the overall mycobiome, although there was some indication that fungal communities might be influenced by high levels of A. fumigatus. Although members of the Onygenales were common in lung samples (92%), they are not common in environmental surveys. Our results indicate that Pneumocystis and certain Onygenales are common commensal members of the lung mycobiome. These results provide new insights into the biology of lung-inhabiting fungi and flag small mammals as potential reservoirs for emerging fungal pathogens.
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Affiliation(s)
| | - Kyana N. Montoya
- Department of Biology, University of New Mexico, Albuquerque, NM, United States
| | - Liliam Montoya
- Department of Plant and Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Kel Cook
- Department of Biology, University of New Mexico, Albuquerque, NM, United States
| | - Schuyler Liphardt
- Department of Biology, University of New Mexico, Albuquerque, NM, United States
| | - John W. Taylor
- Department of Plant and Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Joseph A. Cook
- Department of Biology, University of New Mexico, Albuquerque, NM, United States
- Museum of Southwestern Biology, University of New Mexico, Albuquerque, NM, United States
| | - Donald O. Natvig
- Department of Biology, University of New Mexico, Albuquerque, NM, United States
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45
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Affiliation(s)
- Jennifer Rose-Nussbaumer
- Byers Eye Institute, Stanford University, Palo Alto, California.,Francis I. Proctor Foundation, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco.,Department of Ophthalmology, University of California, San Francisco
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Abstract
Natural and human-made disasters can cause tremendous physical damage, societal change, and suffering. In addition to their effects on people, disasters have been shown to alter the microbial population in the area affected. Alterations for microbial populations can lead to new ecological interactions, with additional potentially adverse consequences for many species, including humans. Disaster-related stressors can be powerful forces for microbial selection. Studying microbial adaptation in disaster sites can reveal new biological processes, including mechanisms by which some microbes could become pathogenic and others could become beneficial (e.g., used for bioremediation). Here we survey examples of how disasters have affected microbiology and suggest that the topic of "disaster microbiology" is itself a new field of study. Given the accelerating pace of human-caused climate change and the increasing encroachment of the natural word by human activities, it is likely that this area of research will become increasingly relevant to the broader field of microbiology. Since disaster microbiology is a broad term open to interpretation, we propose criteria for what phenomena fall under its scope. The basic premise is that there must be a disaster that causes a change in the environment, which then causes an alteration to microbes (either a physical or biological adaptation), and that this adaptation must have additional ramifications.
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Smith DJ, Williams SL, Benedict KM, Jackson BR, Toda M. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis - United States, 2019. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-14. [PMID: 36006889 PMCID: PMC9575547 DOI: 10.15585/mmwr.ss7107a1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PROBLEM/CONDITION Coccidioidomycosis, histoplasmosis, and blastomycosis are underdiagnosed fungal diseases that often mimic bacterial or viral pneumonia and can cause disseminated disease and death. These diseases are caused by inhalation of fungal spores that have distinct geographic niches in the environment (e.g., soil or dust), and distribution is highly susceptible to climate changes such as expanding arid regions for coccidioidomycosis, the northward expansion of histoplasmosis, and areas like New York reporting cases of blastomycosis previously thought to be nonendemic. The national incidence of coccidioidomycosis, histoplasmosis, and blastomycosis is poorly characterized. REPORTING PERIOD 2019. DESCRIPTION OF SYSTEM The National Notifiable Diseases Surveillance System (NNDSS) tracks cases of coccidioidomycosis, a nationally notifiable condition reported to CDC by 26 states and the District of Columbia. Neither histoplasmosis nor blastomycosis is a nationally notifiable condition; however, histoplasmosis is voluntarily reported in 13 states and blastomycosis in five states. Health departments classify cases based on the definitions established by the Council of State and Territorial Epidemiologists. RESULTS In 2019, a total of 20,061 confirmed coccidioidomycosis, 1,124 confirmed and probable histoplasmosis, and 240 confirmed and probable blastomycosis cases were reported to CDC. Arizona and California reported 97% of coccidioidomycosis cases, and Minnesota and Wisconsin reported 75% of blastomycosis cases. Illinois reported the greatest percentage (26%) of histoplasmosis cases. All three diseases were more common among males, and the proportion for blastomycosis (70%) was substantially higher than for histoplasmosis (56%) or coccidioidomycosis (52%). Coccidioidomycosis incidence was approximately four times higher for non-Hispanic American Indian or Alaska Native (AI/AN) persons (17.3 per 100,000 population) and almost three times higher for Hispanic or Latino persons (11.2) compared with non-Hispanic White (White) persons (4.1). Histoplasmosis incidence was similar across racial and ethnic categories (range: 0.9-1.3). Blastomycosis incidence was approximately six times as high among AI/AN persons (4.5) and approximately twice as high among non-Hispanic Asian and Native Hawaiian or other Pacific Islander persons (1.6) compared with White persons (0.7). More than one half of histoplasmosis (54%) and blastomycosis (65%) patients were hospitalized, and 5% of histoplasmosis and 9% of blastomycosis patients died. States in which coccidioidomycosis is not known to be endemic had more cases in spring (March, April, and May) than during other seasons, whereas the number of cases peaked slightly in autumn (September, October, and November) for histoplasmosis and in winter (December, January, and February) for blastomycosis. INTERPRETATION Coccidioidomycosis, histoplasmosis, and blastomycosis are diseases occurring in geographical niches within the United States. These diseases cause substantial illness, with approximately 20,000 coccidioidomycosis cases reported in 2019. Although substantially fewer histoplasmosis and blastomycosis cases were reported, surveillance was much more limited and underdiagnosis was likely, as evidenced by high hospitalization and death rates. This suggests that persons with milder symptoms might not seek medical evaluation and the symptoms self-resolve or the illnesses are misdiagnosed as other, more common respiratory diseases. PUBLIC HEALTH ACTION Improved surveillance is necessary to better characterize coccidioidomycosis severity and to improve detection of histoplasmosis and blastomycosis. These findings might guide improvements in testing practices that enable timely diagnosis and treatment of fungal diseases. Clinicians and health care professionals should consider coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia or other acute infections of the lower respiratory tract who live in or have traveled to areas where the causative fungi are known to be present in the environment. Culturally appropriate tailored educational messages might help improve diagnosis and treatment. Public health response to these three diseases is hindered because information gathered from states' routine surveillance does not include data on populations at risk and sources of exposure. Broader surveillance that includes expansion to other states, and more detail about potential exposures and relevant host factors can describe epidemiologic trends, populations at risk, and disease prevention strategies.
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Coccidioidomycosis in Northern Arizona: an Investigation of the Host, Pathogen, and Environment Using a Disease Triangle Approach. mSphere 2022; 7:e0035222. [PMID: 35972134 PMCID: PMC9599602 DOI: 10.1128/msphere.00352-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coccidioides immitis and Coccidioides posadasii are the etiological agents of coccidioidomycosis (Valley fever [VF]). Disease manifestation ranges from mild pneumonia to chronic or extrapulmonary infection. If diagnosis is delayed, the risk of severe disease increases. In this report, we investigated the intersection of pathogen, host, and environment for VF cases in Northern Arizona (NAZ), where the risk of acquiring the disease is much lower than in Southern Arizona. We investigated reported cases and assessed pathogen origin by comparing genomes of NAZ clinical isolates to isolates from other regions. Lastly, we surveyed regional soils for presence of Coccidioides. We found that cases of VF increased in NAZ in 2019, and Coccidioides NAZ isolates are assigned to Arizona populations using phylogenetic inference. Importantly, we detected Coccidioides DNA in NAZ soil. Given recent climate modeling of the disease that predicts that cases will continue to increase throughout the region, and the evidence presented in this report, we propose that disease awareness outreach to clinicians throughout the western United States is crucial for improving patient outcomes, and further environmental sampling across the western U.S. is warranted. IMPORTANCE Our work is the first description of the Valley fever disease triangle in Northern Arizona, which addresses the host, the pathogen, and the environmental source in the region. Our data suggest that the prevalence of diagnosed cases rose in 2019 in this region, and some severe cases necessitate hospitalization. We present the first evidence of Coccidioides spp. in Northern Arizona soils, suggesting that the pathogen is maintained in the local environment. Until disease prevention is an achievable option via vaccination, we predict that incidence of Valley fever will rise in the area. Therefore, enhanced awareness of and surveillance for coccidioidomycosis is vital to community health in Northern Arizona.
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Williams SL, Chiller T. Update on the Epidemiology, Diagnosis, and Treatment of Coccidioidomycosis. J Fungi (Basel) 2022; 8:jof8070666. [PMID: 35887423 PMCID: PMC9316141 DOI: 10.3390/jof8070666] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Coccidioidomycosis is a fungal infection caused by Coccidioides immitis and Coccidioides posadasii. The dimorphic fungi live in the soils of arid and semi-arid regions of the western United States, as well as parts of Mexico, Central America, and South America. Incidence of disease has risen consistently in recent years, and the geographic distribution of Coccidioides spp. appears to be expanding beyond previously known areas of endemicity. Climate factors are predicted to further extend the range of environments suitable for the growth and dispersal of Coccidioides species. Most infections are asymptomatic, though a small proportion result in severe or life-threatening forms of disease. Primary pulmonary coccidioidomycosis is commonly mistaken for community-acquired pneumonia, often leading to inappropriate antibacterial treatment and unnecessary healthcare costs. Diagnosis of coccidioidomycosis is challenging and often relies on clinician suspicion to pursue laboratory testing. Advancements in diagnostic tools and antifungal therapy developments seek to improve the early detection and effective management of infection. This review will highlight recent updates and summarize the current understanding of the epidemiology, diagnosis, and treatment of coccidioidomycosis.
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Coccidioidomycosis (Valley Fever), Soil Moisture, and El Nino Southern Oscillation in California and Arizona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127262. [PMID: 35742514 PMCID: PMC9223181 DOI: 10.3390/ijerph19127262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
The soil-borne fungal disease coccidioidomycosis (Valley fever) is prevalent across the southwestern United States (US). Previous studies have suggested that the occurrence of this infection is associated with anomalously wet or dry soil moisture states described by the "grow and blow" hypothesis. The growth of coccidioidomycosis is favored by moist conditions both at the surface and in the root zone. A statistical analysis identified two areas in Arizona and central California, with a moderate-to-high number of coccidioidomycosis cases. A Wavelet Transform Coherence (WTC) analysis between El Nino Southern Oscillation (ENSO), coccidioidomycosis cases, surface soil moisture (SSM; 0 to 5 cm) from European Space Agency-Climate Change Initiative (ESA-CCI), and shallow root zone soil moisture (RZSM; 0 to 40 cm depth) from Soil MERGE (SMERGE) was executed for twenty-four CA and AZ counties. In AZ, only SSM was modulated by ENSO. When case values were adjusted for overreporting between 2009 to 2012, a moderate but significant connection between ENSO and cases was observed at a short periodicity (2.1 years). In central CA, SSM, RZSM, and cases all had a significant link to ENSO at longer periodicities (5-to-7 years). This study provides an example of how oceanic-atmospheric teleconnections can impact human health.
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