1
|
Viale MN, López-Joffre MC, Motter AN, Mansilla PE, Vivot FG, Muise Acevedo FM, David VDV, Carrizo SG, Serrano J, Chacón Y, Miranda PC, Alvarez C, Colombres MS, Riera F, Dávalos F, Fernández N, Fernández A, Posse G, Fraenza L, Giordano A, Ampuero A, Amigot S, Guelfand L, Formosa P, Machain M, Saavedra R, Giusiano G, Toranzo AI, Canteros CE. Epidemiology of coccidioidomycosis in Argentina, an update. Med Mycol 2024; 62:myae024. [PMID: 38479781 DOI: 10.1093/mmy/myae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Abstract
The National Reference Laboratory in Clinical Mycology of Argentina conducted a retrospective review of human coccidioidomycosis cases diagnosed by the National Mycology Laboratory Network of Argentina between 2010 and 2022 to determine the burden of the disease in the country. A total of 100 human coccidioidomycosis cases were documented, with a higher prevalence in male patients (male-to-female ratio of 1.9:1), with a median age of 41 years. Comparing the number of cases between two 10-year periods (2000-2009 and 2010-2019), the increase was 36.51% (from 63 to 86 cases). Among the 100 recorded cases, 79 tested positive using the double immunodiffusion test. Spherules were observed in 19 cases through histopathology or direct microscopic examination and the fungus was isolated in 39 cases. Thirty-six isolates were identified as Coccidioides posadasii through partial sequencing of the Ag2/PRA gene. Catamarca province had the highest number of cases, comprising 64% of the total, with an incidence rate above 1.0-2.5/100,000 inhabitants until 2018. However, there has been a recent downward trend in the region from 2018 to 2022. It is concerning that more than half of diagnosed cases were chronic pulmonary or disseminated forms, indicating a lack of early disease detection. To rectify this issue, it is imperative to conduct targeted training programs for healthcare personnel and enhance public awareness within the endemic area. This will contribute to a better understanding of the true burden of coccidioidomycosis and enable the implementation of appropriate sanitary control measures.
Collapse
Affiliation(s)
- Mariana Noelia Viale
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | - María Cecilia López-Joffre
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | - Andrea Nora Motter
- Unidad Operativa Centro de Contención Biológica, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | | | - Flavia Gisele Vivot
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | - Facundo Manuel Muise Acevedo
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | | | | | - Julián Serrano
- Laboratorio de Micología, Hospital Independencia, Argentina
| | | | | | | | | | | | | | - Norma Fernández
- Sección Micología-División Infectología, Hospital de Clínicas José de San Martín, Argentina
| | | | - Gladys Posse
- Hospital Nacional Profesor Alejandro Posadas, Argentina
| | - Laura Fraenza
- Hospital Nacional de Clínicas, Facultad de Ciencias Médicas de Córdoba, Argentina
| | | | | | - Susana Amigot
- Centro De Especialidades Médicas Ambulatorias Rosario, Argentina
| | | | | | - Mónica Machain
- Hospital Interzonal de Agudos Dr. Abraham Piñeyro, Argentina
| | | | - Gustavo Giusiano
- Instituto de Medicina Regional-Departamento Micología-CONICET, Universidad Nacional del Nordeste, Argentina
| | - Adriana Inés Toranzo
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| | - Cristina Elena Canteros
- Departamento Micología, Laboratorio Nacional de Referencia en Micología Clínica, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Argentina
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [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.
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
4
|
Tamura H, Suzuki H, Yamanaka T, Kaiho T, Inage T, Ito T, Tanaka K, Sakairi Y, Wada H, Yoshino I. Surgical treatment for chronic pulmonary coccidioidomycosis: a retrospective study from a single institution. Surg Today 2024; 54:325-330. [PMID: 37555929 DOI: 10.1007/s00595-023-02736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Coccidioidomycosis, caused by the Coccidioides species, is a well-known disease in the Southwestern United States and North Mexico, with scattered reports in Latin America countries. While this disease is still rare in Japan and other Asian countries, its incidence has been increasing over the last two decades. Coccidioides species are highly infectious and require caution when encountered. This study presents a case series of chronic pulmonary coccidioidomycosis surgically treated at a single institution. METHODS We conducted a retrospective chart review of six patients who underwent lung resection for pulmonary coccidioidomycosis at Chiba University Hospital between January 2007 and December 2021. RESULTS All six patients had travelled to the Southwestern United States. Preoperative serology was negative for the anti-Coccidioides antibody in four patients and positive in two. Chest computed tomography revealed a single, well-defined round nodule in all patients. Preoperative biopsy taken from three patients failed to obtain a definitive diagnosis. Histopathological examination of the resected pulmonary nodules revealed granulomas that contained numerous spherules with many endospores, thereby confirming the diagnosis of pulmonary coccidioidomycosis. CONCLUSIONS Pulmonary coccidioidomycosis should be suspected based on travel history and radiological findings. Meticulous care should be taken during specimen processing to prevent cross infection.
Collapse
Affiliation(s)
- Hajime Tamura
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Takahiro Yamanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Taisuke Kaiho
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| |
Collapse
|
5
|
Williams SL, Smith DJ, Benedict K, Ahlers JR, Austin C, Birn R, Carter AM, Christophe NN, Cibulskas K, Cieslak PR, Gibbons-Burgener SN, Gosciminski M, Ireland MJ, Lazenby KV, Loftus T, Lunquest K, Mathewson AA, Nguyen AD, Oltean HN, Osborn B, Petro EM, Power DJ, Reik RR, Schlosser L, Sedivy J, Smelser CB, Chiller T, Toda M. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic - United States, 2019-2021. MMWR Morb Mortal Wkly Rep 2024; 73:239-244. [PMID: 38512795 DOI: 10.15585/mmwr.mm7311a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis.
Collapse
|
6
|
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. Sci Total Environ 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
7
|
Reddy L, Thompson III GR, Tuznik N, Zolfaghari TA, Dray JV, Ames J, Ho D, Crabtree S, Fine J, Wilson MD, Alnimri M, Cohen SH, Koff A. Safety of fluconazole in kidney transplant recipients for prevention of coccidioidomycosis. Med Mycol 2024; 62:myae017. [PMID: 38425102 PMCID: PMC10941972 DOI: 10.1093/mmy/myae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Coccidioides is an endemic fungus that causes infections ranging from mild respiratory illness to life-threatening disease, and immunocompromised hosts such as solid organ transplant recipients are at higher risk for disseminated infection and mortality. Our center administers fluconazole prophylaxis to kidney transplant recipients residing in geographic areas with higher incidences of coccidioidomycosis. However, because drug-drug interactions occur between triazoles and immunosuppressants used in transplant medicine, we undertook a study to ascertain whether fluconazole prophylaxis was associated with any important safety outcomes in kidney transplant recipients. This retrospective study evaluated patients who had undergone kidney transplantation between 2016 and 2019. Data on patient demographics, transplant-related clinical information, use of fluconazole prophylaxis (200 mg daily for 6-12 months post-transplant), and patient outcomes were obtained. The primary outcome was mean estimated glomerular filtration rate (eGFR) at 12 months, comparing those who received fluconazole prophylaxis to those who did not. Secondary outcomes included mean eGFR at 3 months, 6 months, and 9 months post-transplant, patient survival, biopsy-proven graft rejection, graft loss, or a new requirement for post-transplant dialysis, all within 12 months post-transplant. The mean eGFR at 12 months was similar between both groups, with 66.4 ml/min/1.73 m² in the fluconazole prophylaxis group vs. 64.3 ml/min/1.73 m² in the non-fluconazole prophylaxis group (P = 0.55). Secondary outcomes were similar across both groups. Multivariable linear regression found no significant association between fluconazole use and graft function. Fluconazole prophylaxis for prevention of coccidioidomycosis was not associated with adverse graft outcomes in kidney transplant recipients.
Collapse
Affiliation(s)
- Laya Reddy
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - George R Thompson III
- 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
| | - Natascha Tuznik
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - Tina A Zolfaghari
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Joy Vongspanich Dray
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Janneca Ames
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Daniel Ho
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Scott Crabtree
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Machelle D Wilson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Muna Alnimri
- Department of Internal Medicine, Division of Nephrology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Stuart H Cohen
- 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
| | - Alan Koff
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
8
|
Porter WT, Gade L, Montfort P, Mihaljevic JR, Bowers JR, Willman A, Klimowski BA, LaFleur BJ, Sunenshine RH, Collins J, Adame G, Brady S, Komatsu KK, Williams S, Toda M, Chiller T, Litvintseva AP, Engelthaler DM. Understanding the exposure risk of aerosolized Coccidioides in a Valley fever endemic metropolis. Sci Rep 2024; 14:1311. [PMID: 38225347 PMCID: PMC10789871 DOI: 10.1038/s41598-024-51407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
Coccidioides is the fungal causative agent of Valley fever, a primarily pulmonary disease caused by inhalation of fungal arthroconidia, or spores. Although Coccidioides has been an established pathogen for 120 years and is responsible for hundreds of thousands of infections per year, little is known about when and where infectious Coccidioides arthroconidia are present within the ambient air in endemic regions. Long-term air sampling programs provide a means to investigate these characteristics across space and time. Here we present data from > 18 months of collections from 11 air sampling sites across the Phoenix, Arizona, metropolitan area. Overall, prevalence was highly variable across space and time with no obvious spatial or temporal correlations. Several high prevalence periods were identified at select sites, with no obvious spatial or temporal associations. Comparing these data with weather and environmental factor data, wind gusts and temperature were positively associated with Coccidioides detection, while soil moisture was negatively associated with Coccidioides detection. These results provide critical insights into the frequency and distribution of airborne arthroconidia and the associated risk of inhalation and potential disease that is present across space and time in a highly endemic locale.
Collapse
Affiliation(s)
- W Tanner Porter
- Pathogen & Microbiome Division, Translational Genomics Research Institute, Flagstaff, AZ, USA.
| | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Parker Montfort
- Pathogen & Microbiome Division, Translational Genomics Research Institute, Flagstaff, AZ, USA
| | - Joseph R Mihaljevic
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, USA
| | - Jolene R Bowers
- Pathogen & Microbiome Division, Translational Genomics Research Institute, Flagstaff, AZ, USA
| | | | | | - Bonnie J LaFleur
- College of Pharmacy, The University of Arizona, Phoenix, AZ, USA
| | | | | | | | - Shane Brady
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | - Samantha Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David M Engelthaler
- Pathogen & Microbiome Division, Translational Genomics Research Institute, Flagstaff, AZ, USA
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
10
|
Abad CLR, Razonable RR. Donor-derived endemic mycoses after solid organ transplantation: A review of reported cases. Clin Transplant 2024; 38:e15199. [PMID: 37991084 DOI: 10.1111/ctr.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Donor-derived endemic mycoses are infrequently reported. We summarized the clinical characteristics and outcomes of these infections to provide guidance to transplant clinicians. METHODS Multiple databases were reviewed from inception through May 31, 2023 using endemic fungi as key words (e.g., Coccidioides, histoplasma, blastomyces, talaromyces, paracoccidioides). Only donor-derived infections (DDI) were included. RESULTS Twenty-four cases of DDI were identified from 18 published reports; these included 16 coccidioidomycosis, seven histoplasmosis, and one talaromycosis. No cases of blastomycosis and paracoccidiodomycosis were published. The majority were male (17/24,70.8%). Half of the cases were probable (12/24, 50%), seven were possible (29.2%), and only five were proven DDI (20.8%). Donor-derived coccidioidomycosis were observed in kidney (n = 11), lung (n = 6), liver (n = 3), heart (n = 2) and combined SOT recipients (1 KP, 1 KL) at a median time of .9 (range .2-35) months after transplantation. For histoplasmosis, the majority were kidney recipients (6 of 7 cases) at a median onset of 8 (range .4-48) months after transplantation. The single reported possible donor-derived talaromycosis occurred in a man whose organ donor had at-risk travel to Southeast Asia. Collectively, the majority of donors had high-risk exposure to Coccidioides (9/11) or Histoplasma sp. (6/6). Most donor-derived endemic mycoses were disseminated (18/24, 75%), and mortality was reported in almost half of recipients (11/24, 45.8%). CONCLUSION Donor-derived endemic mycoses are often disseminated and are associated with high mortality. A detailed evaluation of donors for the potential of an undiagnosed fungal infection prior to organ donation is essential to mitigate the risk of these devastating infections.
Collapse
Affiliation(s)
- Cybele Lara R Abad
- Department of Medicine, Section of Infectious Diseases, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Raymund R Razonable
- Department of Medicine, Division of Infectious Diseases, and The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| |
Collapse
|
11
|
Bahr NC, Thompson GR. Endemic mycoses - are we making progress in management? Curr Opin Infect Dis 2023; 36:436-442. [PMID: 37755392 PMCID: PMC10840811 DOI: 10.1097/qco.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The endemic fungi are a significant cause of morbidity and mortality in effected patients. The range of endemicity for these are expanding with infections observed outside of traditional locations. Enhanced diagnostic and treatment practices may significantly alter patient outcomes. RECENT FINDINGS Recently completed clinical trials have focused on an assessment of improving efficacy while minimizing patient toxicity. Practice changing trials have been completed in histoplasmosis showing the utility of a single up-front liposomal amphotericin B dose followed by standard itraconazole dosing. The recent evaluation of several antifungal options including isauvconazole in the treatment of coccidioidomycosis also show promise for additional therapeutic agents. A recently conducted trial has also shown the superiority of amphotericin B therapy over itraconazole in the treatment of talaromycosis. SUMMARY The increased range of endemic mycoses coupled with the growing immunocompromised patient population mandates continued investigation of improved diagnostic and therapeutic options. Advances in these areas have led to more rapid diagnosis and more efficacious antifungal therapy.
Collapse
Affiliation(s)
- Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, USA
| |
Collapse
|
12
|
Policepatil SM, Sivasubramanian G. Diagnostic delays in cutaneous coccidioidomycosis: A report from Central California. Med Mycol 2023; 61:myad107. [PMID: 37863836 DOI: 10.1093/mmy/myad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 10/22/2023] Open
Abstract
Cutaneous Coccidioidomycosis (CC) infection can present with a wide variety of clinical presentations and is well known as a 'great imitator'. We performed a retrospective analysis of patients with CC in a large referral center in Central Valley, California, from 2010 to 2022 using the ICD9 and ICD10 codes for coccidioidomycosis and CC. We identified 40 patients with CC during the study period. The mean age of the study population was 43 years (with standard deviation of 14.08). Among these, 60% were men and 40% women. The appearance of the lesions varied from ulcers, plaques, nodules, blisters, cellulitis, and abscesses. The most common site of CC lesions was in the lower extremities (42.5%), followed by upper extremities (30%), chest and abdomen, head and neck (25% each). Only 22.5% of the 40 cases were diagnosed as CC and 15% were diagnosed as erythema nodosum. Rest were diagnosed initially as bacterial cellulitis in 37.5%, tinea in 7.5%, and others in 12.5%. There was resolution of the cutaneous lesions in all patients with antifungal treatment. The mean time of diagnosis from onset of symptoms on an average was 12 weeks (8-16 weeks) in our study with 75% cases initially misdiagnosed. Comprehensive knowledge about the manifestations and evaluation of CC among primary care providers and emergency room physicians is essential to prevent delays in diagnosis and treatment.
Collapse
Affiliation(s)
- Seema M Policepatil
- Department of Internal Medicine, University of California San Francisco Fresno, Fresno, CA, USA
| | - Geetha Sivasubramanian
- Department of Internal Medicine, University of California San Francisco Fresno, Fresno, CA, USA
- Division of Infectious Diseases, University of California San Francisco Fresno, Fresno, CA, USA
| |
Collapse
|
13
|
Rozier LS, Mullaney SB, Thompson Iii GR, Moore GD, Ajufoh CO, Gerardo AA, Sykes JE. Coccidioides spp. exposure among military working dogs in endemic regions of the United States. Med Mycol 2023; 61:myad109. [PMID: 37935009 DOI: 10.1093/mmy/myad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
Coccidioidomycosis is a fungal disease in arid regions of the United States that is predicted to expand with climate change. Cases in military personnel and military working dogs (MWDs) impact personnel readiness and result in healthcare costs. To examine Coccidioides exposure among MWDs, 276 banked serum samples were retrieved from dogs housed in California, Texas, Arizona, New Mexico, Nevada, and Utah. Using gel immunodiffusion, six (2.1%) specimens were IgG-positive and three (1.1%) were equivocally IgM-positive. The IgG-positive samples were from Arizona (2 [prevalence 8.0%]) and California (4 [3.7%]). These data will guide future efforts to study MWDs as sentinels for human coccidioidomycosis.
Collapse
Affiliation(s)
- Lege S Rozier
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Sara B Mullaney
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - George R Thompson Iii
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health, Sacramento, CA 95817, USA
- Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA
| | - Gerald D Moore
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Chiweta O Ajufoh
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Angelina A Gerardo
- Department of Defense Military Working Dog Veterinary Service, Lackland Air force base, 78236, USA
| | - Jane E Sykes
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| |
Collapse
|
14
|
Zangeneh TT, Lainhart WD, Wiederhold NP, Al-Obaidi MM. Coccidioides species antifungal susceptibility testing: Experience from a large healthcare system in the endemic region. Med Mycol 2023; 61:myad104. [PMID: 37804176 DOI: 10.1093/mmy/myad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023] Open
Abstract
The clinical utility of Coccidioides species antifungal susceptibility testing (AST) remains unclear. This study describes the clinical course of eight patients with severe or chronic coccidioidomycosis and subsequent Coccidioides AST. We present the clinical manifestations, antifungal treatment regimens, and clinical outcomes for these patients.
Collapse
Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - William D Lainhart
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
| |
Collapse
|
15
|
Ashizawa H, Iwanaga N, Kurohama H, Ito Y, Ashizawa N, Hirayama T, Takeda K, Ide S, Nagayoshi Y, Tashiro M, Takazono T, Tagawa T, Fukushima K, Ito M, Nakamura S, Izumikawa K, Yanagihara K, Miyazaki Y, Mukae H. Pulmonary Coccidioidomycosis Complicated by Nontuberculous Mycobacterial Pulmonary Diseases with a Literature Review. Jpn J Infect Dis 2023; 76:314-318. [PMID: 37258176 DOI: 10.7883/yoken.jjid.2023.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Following an endobronchial examination, a young mine supervisor was treated with antibiotics for a pulmonary nontuberculous mycobacterial infection for approximately one year. However, a review of the radiological findings revealed a different possibility. Accordingly, pulmonary resection was performed, and histopathological analysis revealed numerous yeast-like fungi. Since the patient had stayed in the southwestern United States for two months in 2009, eight years previously, coccidioidomycosis was strongly suspected. The diagnosis of coccidioidomycosis was subsequently confirmed by serology and polymerase chain reaction testing of the excised specimen. Here, we report an educational case that emphasizes the importance of meticulous medical history-taking and awareness of endemic mycoses in other countries in the context of globalization.
Collapse
Affiliation(s)
- Hiroki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
| | - Naoki Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
| | - Hirokazu Kurohama
- Department of Pathology, Nagasaki University Hospital, Japan
- Department of Pathology, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Yuya Ito
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
| | - Tatsuro Hirayama
- Department of Pharmacotherapeutics, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Infectious Diseases Experts Training Center, Nagasaki University Hospital, Japan
| | - Yohsuke Nagayoshi
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
- Division of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Japan
| | - Masato Tashiro
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Kiyoyasu Fukushima
- Division of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Japan
| | - Masahiro Ito
- Department of Pathology, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Shigeki Nakamura
- Department of Microbiology, Tokyo Medical University, Japan
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Koichi Izumikawa
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| |
Collapse
|
16
|
Blow A. Valley Fever Is a Growing Fungal Threat to Outdoor Workers. Nature 2023; 621:S38-S39. [PMID: 37730871 DOI: 10.1038/d41586-023-02616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
|
17
|
Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
Collapse
Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| |
Collapse
|
18
|
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] [What about the content of this article? (0)] [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.
Collapse
|
19
|
Wagner R, Montoya L, Head JR, Campo S, Remais J, Taylor JW. Coccidioides undetected in soils from agricultural land and uncorrelated with time or the greater soil fungal community on undeveloped land. PLoS Pathog 2023; 19:e1011391. [PMID: 37228157 PMCID: PMC10246812 DOI: 10.1371/journal.ppat.1011391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/07/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Coccidioidomycosis is a typically respiratory fungal disease that, in the United States, occurs primarily in Arizona and California. In California, most coccidioidomycosis cases occur in the San Joaquin Valley, a primarily agricultural region where the disease poses a risk for outdoor workers. We collected 710 soil samples and 265 settled dust samples from nine sites in the San Joaquin Valley and examined how Coccidioides detection varied by month, site, and the presence and abundance of other fungal species. We detected Coccidioides in 89 of 238 (37.4%) rodent burrow soil samples at five undeveloped sites and were unable to detect Coccidioides in any of 472 surface and subsurface soil samples at four agricultural sites. In what is the largest sampling effort undertaken on agricultural land, our results provide no evidence that agricultural soils in the San Joaquin Valley harbor Coccidioides. We found no clear association between Coccidioides and the greater soil fungal community, but we identified 19 fungal indicator species that were significantly associated with Coccidioides detection in burrows. We also did not find a seasonal pattern in Coccidioides detection in the rodent burrow soils we sampled. These findings suggest both the presence of a spore bank and that coccidioidomycosis incidence may be more strongly associated with Coccidioides dispersal than Coccidioides growth. Finally, we were able to detect Coccidioides in only five of our 265 near-surface settled dust samples, one from agricultural land, where Coccidioides was undetected in soils, and four from undeveloped land, where Coccidioides was common in the rodent burrow soils we sampled. Our ability to detect Coccidioides in few settled dust samples indicates that improved methods are likely needed moving forward, though raises questions regarding aerial dispersal in Coccidioides, whose key transmission event likely occurs over short distances in rodent burrows from soil to naïve rodent lungs.
Collapse
Affiliation(s)
- Robert Wagner
- Department of Plant & Microbial Biology, University of California Berkeley, Berkeley, California, United States of America
| | - Liliam Montoya
- Department of Plant & Microbial Biology, University of California Berkeley, Berkeley, California, United States of America
| | - Jennifer R. Head
- Division of Epidemiology, University of California Berkeley, Berkeley, California, United States of America
| | - Simon Campo
- Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, United States of America
| | - Justin Remais
- Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, United States of America
| | - John W. Taylor
- Department of Plant & Microbial Biology, University of California Berkeley, Berkeley, California, United States of America
| |
Collapse
|
20
|
Campbell AP, Qiu L, Dillman JR, Trout AT, Szabo S, Lopez-Nunez OF, Pugmire BS, Schapiro AH. Endemic mycoses in children in North America: a review of radiologic findings. Pediatr Radiol 2023; 53:984-1004. [PMID: 36922418 PMCID: PMC10017348 DOI: 10.1007/s00247-023-05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.
Collapse
Affiliation(s)
- Abraham P Campbell
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Lisa Qiu
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Szabo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oscar F Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian S Pugmire
- Department of Radiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Andrew H Schapiro
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
21
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
22
|
Naeem F, Laningham F, Giglio L, Sharma J, Clerkin PQ, McCarty JM. Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series. Pediatr Infect Dis J 2023; 42:286-291. [PMID: 36728889 DOI: 10.1097/inf.0000000000003813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Published literature on central nervous system (CNS) coccidioidomycosis in children is limited. Here we describe a large case series of pediatric CNS coccidioidomycosis from a tertiary care center in an endemic region. METHOD This is a retrospective case review of patients ≤21 years old with a diagnosis of CNS coccidioidomycosis from January 1, 2000, to December 31, 2018. RESULTS Thirty patients (median age 10.8 years) were identified and most (93%) were previously healthy. Fever (90%), headache (70%), vomiting (53%), and fatigue (57%) were the most common presenting clinical manifestations, with focal neurological signs/symptoms present in 14 (47%). The initial serum Coccidioides compliment fixation (CF) titer was ≤ 1:8 in 33%. Most patients had extra-axial brain involvement (83%) and seven (23%) had associated spinal cord disease. Shunt placement was required in 70% and 62% required revision. Fluconazole was the initial treatment in 22 (73%), with treatment failure occurring in 50%. Most patients (77%) stabilized and were maintained on suppressive therapy, 4 (13%) experienced relapses and/or progressive disease, and one (3%) died, while long-term neurological complications occurred in 17%. CONCLUSIONS CNS coccidioidomycosis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers and hydrocephalus is common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed.
Collapse
Affiliation(s)
- Fouzia Naeem
- Division of Infectious Disease, Department of Pediatrics, Valley Children's Healthcare, Madera, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Fred Laningham
- Division of Neurosurgery, Department of Pediatrics, Valley Children's Healthcare, Madera, California
| | - Linda Giglio
- Division of Radiology, Department of Pediatrics, Valley Children's Healthcare, Madera, California
| | - Julia Sharma
- Division of Radiology, Department of Pediatrics, Valley Children's Healthcare, Madera, California
| | - Patricia Quebada Clerkin
- Department of Pediatric Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James M McCarty
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
23
|
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] [What about the content of this article? (0)] [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.
Collapse
|
24
|
Shemuel J, Bays DJ, Thompson GR, Reef S, Snyder L, Freifeld AJ, Huppert M, Salkin D, Wilson MD, Galgiani JN. Natural history of pulmonary coccidioidomycosis: Further examination of the VA-Armed Forces Database. Med Mycol 2022; 60:myac054. [PMID: 36166843 PMCID: PMC9614921 DOI: 10.1093/mmy/myac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 02/02/2023] Open
Abstract
There are still many limitations related to the understanding of the natural history of differing forms of coccidioidomycosis (CM), including characterizing the spectrum of pulmonary disease. The historical Veterans Administration-Armed Forces database, recorded primarily before the advent of antifungal therapy, presents an opportunity to characterize the natural history of pulmonary CM. We performed a retrospective cohort study of 342 armed forces service members who were diagnosed with pulmonary CM at VA facilities between 1955 to 1958, followed through 1966, who did not receive antifungal therapy. Patients were grouped by predominant pulmonary finding on chest radiographs. The all-cause mortality was low for all patients (4.6%). Cavities had a median size of 3-3.9 cm (IQR: 2-2.9-4-4.9 cm), with heterogeneous wall thickness and no fluid level, while nodules had a median size of 1-1.19 cm (Interquartile range [IQR] 1-1.9-2-2.9 cm) and sharp borders. The majority of cavities were chronic (85.6%), and just under half were found incidentally. Median complement fixation titers in both the nodular and cavitary groups were negative, with higher titers in the cavitary group overall. This retrospective cohort study of non-disseminated coccidioidomycosis, the largest to date, sheds light on the natural history, serologic markers, and radiologic characteristics of this understudied disease. These findings have implications for the evaluation and management of CM.
Collapse
Affiliation(s)
- Joseph Shemuel
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Derek J Bays
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health, Sacramento, California, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health, Sacramento, California, USA
- Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA
| | - Susan Reef
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Snyder
- Department of Internal Medicine, Division of Pulmonary/Critical Care and Palliative Medicine, University of Arizona-Tucson, Tucson, Arizona, USA
| | - Alana J Freifeld
- Department of Internal Medicine, University of Colorado, Boulder, Colorado, USA
| | | | | | - Machelle D Wilson
- Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, California, USA
| | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| |
Collapse
|
25
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
26
|
Ashcherkin N, Gupta S, Huff DA, Vikram HR, Ampel NM, Fischer KM, Blair JE. Impact of COVID-19 on diagnosis of primary pulmonary coccidioidomycosis. Medicine (Baltimore) 2022; 101:e30361. [PMID: 36107584 PMCID: PMC9439624 DOI: 10.1097/md.0000000000030361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The COVID-19 pandemic has disrupted medical care worldwide and caused delays in care for many illnesses and procedures unrelated to COVID-19; however, less clear is how it may have affected diagnosis of conditions that present with similar symptoms, such as primary pulmonary coccidioidomycosis (PPC). We conducted an observational cohort study of patients diagnosed with PPC between March 1 and December 1 in 2 years: 2019 (before COVID-19) and in 2020 (after COVID-19) to compare the time from symptom onset to PPC diagnosis. Relevant demographic and clinical variables were collected, and statistical analyses were performed with the χ2 test, Wilcoxon rank sum test, and Cox proportional hazards regression analysis. During 2019, 83 patients were diagnosed with PPC. During 2020, 113 patients were diagnosed with PPC. For both groups, the median time from symptom onset to diagnosis of PPC was 14 days (P = .13). No significant differences in time to diagnosis existed between the 2 years for location of diagnosis (outpatient clinic, emergency department, or in hospital), for computed tomographic imaging performed before diagnosis, or for number of COVID-19 tests received before PPC diagnosis. In addition, there were no differences in the 2 years between the total number of clinical visits before diagnosis. However, patients in the post-COVID-19 group who had fever were diagnosed with PPC earlier than those without fever (hazard ratio, 1.77; 95% confidence interval, 1.15-2.73; P = .01). Contrary to what we expected, no significant delay in diagnosis of PPC occurred during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Nikita Ashcherkin
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona, USA
| | - Simran Gupta
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona, USA
| | - Daniel A. Huff
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona, USA
| | | | - Neil M. Ampel
- Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Karen M. Fischer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Janis E. Blair
- Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA
- *Correspondence: Janis E. Blair, Division of Infectious Diseases, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA (e-mail: )
| |
Collapse
|
27
|
Ellis GC, Lanteri CA, Hsieh HC, Graf PCF, Pineda G, Crum-Cianflone NF, Berjohn CM, Sanders T, Maves RC, Deiss R. Coccidioidomycosis Seroincidence and Risk among Military Personnel, Naval Air Station Lemoore, San Joaquin Valley, California, USA 1. Emerg Infect Dis 2022; 28:1842-1846. [PMID: 35997543 PMCID: PMC9423930 DOI: 10.3201/eid2809.220652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective cohort study that tested 2,000 US military personnel for Coccidioides antibodies in a disease-endemic region. The overall incidence of seroconversion was 0.5 cases/100 person-years; 12.5% of persons who seroconverted had illnesses requiring medical care. No significant association was found between demographic characteristics and seroconversion or disease.
Collapse
|
28
|
Donnelly MAP, Maffei D, Sondermeyer Cooksey GL, Ferguson TJ, Jain S, Vugia D, Materna BL, Kamali A. Notes From the Field: Coccidioidomycosis Outbreak Among Wildland Firefighters — California, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:1095-1096. [PMID: 36006835 PMCID: PMC9422962 DOI: 10.15585/mmwr.mm7134a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
29
|
Smith DJ, Williams SL, Benedict KM, Jackson BR, Toda M. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis - United States, 2019. MMWR Surveill Summ 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] [What about the content of this article? (0)] [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.
Collapse
|
30
|
Ramadan FA, Ellingson KD, Canales RA, Bedrick EJ, Galgiani JN, Donovan FM. Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA. Emerg Infect Dis 2022; 28:1091-1100. [PMID: 35608552 PMCID: PMC9155888 DOI: 10.3201/eid2806.212311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Demographic and clinical indicators have been described to support identification of coccidioidomycosis; however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected coccidioidomycosis in emergency departments and inpatient units in Coccidioides-endemic regions. We aimed to develop a predictive model among participants with suspected coccidioidomycosis. We applied a least absolute shrinkage and selection operator to specific coccidioidomycosis predictors and developed univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a statistically significant predictive feature of coccidioidomycosis in both inpatient and outpatient settings. Our multivariable outpatient model also identified rash (adjusted odds ratio 9.74 [95% CI 1.03–92.24]; p = 0.047) as a predictor. Our results suggest preliminary support for developing a coccidioidomycosis prediction model for use in clinical settings.
Collapse
|
31
|
Guo X, Ruan Q, Jin J, Zheng J, Shao L, Li N, Zhu L, Zhang W, Hu Y, Chen M. Disseminated coccidioidomycosis in immunocompetent patients in non-endemic areas: a case series and literature review. Eur J Clin Microbiol Infect Dis 2022; 41:925-939. [PMID: 35546215 DOI: 10.1007/s10096-022-04447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Coccidioidomycosis is caused by the dimorphic fungi Coccidioides species which is endemic in the Western hemisphere. Reports on the characteristics of travel-related disseminated coccidioidomycosis in immunocompetent patients are rare, especially in non-endemic regions. The multifaceted symptoms of this condition present a diagnostic challenge to clinicians. This study aimed to review immunocompetent patients diagnosed with disseminated coccidioidomycosis in a tertiary hospital in Eastern China and other non-endemic areas, and to emphasize the importance of combining travel history with clinical manifestations and proper diagnostic examinations. This study retrospectively reviewed a case series of disseminated coccidioidomycosis diagnosed in an academic hospital in Eastern China. We conducted a global literature review of disseminated coccidioidomycosis in immunocompetent patients with travel history. We identified six patients in our case series and reviewed 42 cases in the literature. Travel history included Mexico, Arizona, California, and regions of low endemicity. Extrapulmonary sites of infection, which presented with diverse signs and symptoms, involved the skin and soft tissue, musculoskeletal system, lymph nodes, and central nervous system. Misdiagnoses and diagnostic delays were common. Next-generation sequencing substantially promoted precise diagnosis in our series. The overall prognosis for immunocompetent individuals was positive, mainly benefited from long-term azole therapies. The patients that succumbed had either central nervous system involvement or multiorgan dissemination. Progressive pneumonia with varied symptoms and travel history should alert healthcare professionals in non-endemic areas to consider the possibility of Coccidioides species infection. We recommend detailed history-taking and hypothesis-free detection of pathogens for cases with diagnostic delay.
Collapse
Affiliation(s)
- Xiaoxiao Guo
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiaoling Ruan
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jialin Jin
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianming Zheng
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingyun Shao
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ning Li
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liping Zhu
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenhong Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Medical Molecular Virology (MOE/MOH) Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuekai Hu
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Mingquan Chen
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
32
|
Huff D, Ampel NM, Blair JE. Coccidioidomycosis and COVID-19 Infection. An Analysis from a Single Medical Center Within the Coccidioidal Endemic Area. Mycopathologia 2022; 187:199-204. [PMID: 35428955 PMCID: PMC9012435 DOI: 10.1007/s11046-022-00629-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/23/2022] [Indexed: 01/28/2023]
Abstract
At a single medical center, we identified 60 cases of coccidioidomycosis that were coincident with COVID-19 infection. Among these, seven patients developed new or clinically progressive coccidioidomycosis. Receipt of dexamethasone for COVID-19 infection was the only significant risk factor for the progression or development of clinically active coccidioidomycosis in this cohort. All patients survived and none developed disseminated coccidioidomycosis.
Collapse
Affiliation(s)
- Daniel Huff
- Department of Medicine, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Neil M Ampel
- The Division of Infectious Diseases of Mayo Clinic in Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Janis E Blair
- The Division of Infectious Diseases of Mayo Clinic in Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
| |
Collapse
|
33
|
de Melo Teixeira M, Stajich JE, Sahl JW, Thompson GR, Brem RB, Dubin CA, Blackmon AV, Mead HL, Keim P, Barker BM. A chromosomal-level reference genome of the widely utilized Coccidioides posadasii laboratory strain "Silveira". G3 (Bethesda) 2022; 12:jkac031. [PMID: 35137016 PMCID: PMC8982387 DOI: 10.1093/g3journal/jkac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
Coccidioidomycosis is a common fungal disease that is endemic to arid and semi-arid regions of both American continents. Coccidioides immitis and Coccidioides posadasii are the etiological agents of the disease, also known as Valley Fever. For several decades, the C. posadasii strain Silveira has been used widely in vaccine studies, is the source strain for production of diagnostic antigens, and is a widely used experimental strain for functional studies. In 2009, the genome was sequenced using Sanger sequencing technology, and a draft assembly and annotation were made available. In this study, the genome of the Silveira strain was sequenced using single molecule real-time sequencing PacBio technology, assembled into chromosomal-level contigs, genotyped, and the genome was reannotated using sophisticated and curated in silico tools. This high-quality genome sequencing effort has improved our understanding of chromosomal structure, gene set annotation, and lays the groundwork for identification of structural variants (e.g. transversions, translocations, and copy number variants), assessment of gene gain and loss, and comparison of transposable elements in future phylogenetic and population genomics studies.
Collapse
Affiliation(s)
- Marcus de Melo Teixeira
- Faculty of Medicine, University of Brasília, Brasília 70910-900, Brazil
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Jason E Stajich
- Institute for Integrative Genome Biology, University of California Riverside, Riverside, CA 92521, USA
- Department of Microbiology and Plant Pathology, University of California Riverside, Riverside, CA 92521, USA
| | - Jason W Sahl
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - George R Thompson
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA 95616, USA
| | - Rachel B Brem
- Department of Plant and Microbial Biology, University of California Berkeley, Berkeley, CA 94720, USA
| | - Claire A Dubin
- Department of Plant and Microbial Biology, University of California Berkeley, Berkeley, CA 94720, USA
| | - Austin V Blackmon
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Heather L Mead
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Paul Keim
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Bridget M Barker
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| |
Collapse
|
34
|
Abstract
We describe 73 patients with coccidioidomycosis diagnosed or treated at a regional referral center in West Texas, USA. Patients most at risk worked in oil production or agriculture; the most-associated health factors were smoking and diabetes. Patient demographics suggest that access to care may affect coccidioidomycosis diagnosis in this region.
Collapse
|
35
|
Chaturvedi S, Victor TR, Marathe A, Sidamonidze K, Crucillo KL, Chaturvedi V. Real-time PCR assay for detection and differentiation of Coccidioides immitis and Coccidioides posadasii from culture and clinical specimens. PLoS Negl Trop Dis 2021; 15:e0009765. [PMID: 34529679 PMCID: PMC8486383 DOI: 10.1371/journal.pntd.0009765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/01/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Coccidioidomycosis (Valley fever) is a pulmonary and systemic fungal disease with increasing incidence and expanding endemic areas. The differentiation of etiologic agents Coccidioides immitis and C. posadasii remains problematic in the clinical laboratories as conventional PCR and satellite typing schemes are not facile. Therefore, we developed Cy5- and FAM-labeled TaqMan-probes for duplex real-time PCR assay for rapid differentiation of C. immitis and C. posadasii from culture and clinical specimens. The RRA2 gene encoding proline-rich antigen 2, specific for Coccidioides genus, was the source for the first set of primers and probe. Coccidioides immitis contig 2.2 (GenBank: AAEC02000002.1) was used to design the second set of primers and probe. The second primers/probe did not amplify the corresponding C. posadasii DNA, because of an 86-bp deletion in the contig. The assay was highly sensitive with limit of detection of 0.1 pg gDNA/PCR reaction, which was equivalent to approximately ten genome copies of C. immitis or C. posadasii. The assay was highly specific with no cross-reactivity to the wide range of fungal and bacterial pathogens. Retrospective analysis of fungal isolates and primary specimens submitted from 1995 to 2020 confirmed 168 isolates and four primary specimens as C. posadasii and 30 isolates as C. immitis from human coccidioidomycosis cases, while all eight primary samples from two animals (rhesus monkey and rhinoceros) were confirmed as C. posadasii. A preliminary analysis of cerebrospinal fluid (CSF) and pleural fluid samples showed positive correlation between serology tests and real-time PCR for two of the 15 samples. The Coccidioides spp. duplex real-time PCR will allow rapid differentiation of C. immitis and C. posadasii from clinical specimens and further augment the treatment and surveillance of coccidioidomycosis.
Collapse
Affiliation(s)
- Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Sciences, University at Albany, Albany, New York, United States of America
- * E-mail: (SC); (VC)
| | - Tanya R. Victor
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Anuradha Marathe
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Ketevan Sidamonidze
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Kelly L. Crucillo
- Coccidioidomycosis Serology Laboratory, Department of Medical Microbiology and Immunology, University of California School of Medicine, Davis, California, United States of America
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- * E-mail: (SC); (VC)
| |
Collapse
|
36
|
Carey A, Gorris ME, Chiller T, Jackson B, Beadles W, Webb BJ. Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006-2015. Emerg Infect Dis 2021; 27:2269-2277. [PMID: 34423764 PMCID: PMC8386810 DOI: 10.3201/eid2709.210751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
On the basis of a 1957 geographic Coccidioides seropositivity survey, 3 counties in southwestern Utah, USA, were considered coccidioidomycosis-endemic, but there has been a paucity of information on the disease burden in Utah since. We report findings from a recent clinical and epidemiologic study of coccidioidomycosis in Utah. To describe clinical characteristics, we identified all coccidioidomycosis cases in an integrated health system in the state during 2006-2015. For epidemiologic analysis, we used cases reported to the Utah Department of Health during 2009-2015. Mean state incidence was 1.83 cases/100,000 population/year. Washington County, in southwestern Utah, had the highest incidence, 17.2 cases/100,000 population/year. In a generalized linear model with time as a fixed effect, mean annual temperature, population, and new construction were associated with regional variations in incidence. Using these variables in a spatiotemporal model, we estimated the adjusted regional variation by county to predict areas where Coccidioides infections might increase.
Collapse
|
37
|
de Melo Teixeira M, Lang BF, Matute DR, Stajich JE, Barker BM. Mitochondrial genomes of the human pathogens Coccidioides immitis and Coccidioides posadasii. G3 (Bethesda) 2021; 11:jkab132. [PMID: 33871031 PMCID: PMC8496281 DOI: 10.1093/g3journal/jkab132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
Abstract
Fungal mitochondrial genomes encode genes involved in crucial cellular processes, such as oxidative phosphorylation and mitochondrial translation, and the molecule has been used as a molecular marker for population genetics studies. Coccidioides immitis and C. posadasii are endemic fungal pathogens that cause coccidioidomycosis in arid regions across both American continents. To date, approximately 150 Coccidioides isolates have been sequenced to infer patterns of variation in nuclear genomes. However, less attention has been given to the mitochondrial genomes of Coccidioides. In this report, we describe the assembly and annotation of mitochondrial reference genomes for two representative strains of C. posadasii and C. immitis, as well as assess population variation among 77 selected genomes. The sizes of the circular-mapping molecules are 68.2 Kb in C. immitis and 75.1 Kb in C. posadasii. We identify 14 mitochondrial protein-coding genes common to most fungal mitochondria, which are largely syntenic across different populations and species of Coccidioides. Both Coccidioides species are characterized by a large number of group I and II introns, harboring twice the number of elements as compared to closely related Onygenales. The introns contain complete or truncated ORFs with high similarity to homing endonucleases of the LAGLIDADG and GIY-YIG families. Phylogenetic comparisons of mitochondrial and nuclear genomes show extensive phylogenetic discordance suggesting that the evolution of the two types of genetic material is not identical. This work represents the first assessment of mitochondrial genomes among isolates of both species of Coccidioides, and provides a foundation for future functional work.
Collapse
Affiliation(s)
- Marcus de Melo Teixeira
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
- Faculty of Medicine, University of Brasília-DF, Brasília, Federal District 70910-3300, Brazil
| | - B Franz Lang
- Robert Cedergren Centre for Bioinformatics and Génomiques, Département de Biochimie, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Daniel R Matute
- Biology Department, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jason E Stajich
- Institute for Integrative Genome Biology, University of California, Riverside, CA 92521, USA
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA 92521, USA
| | - Bridget M Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA
| |
Collapse
|
38
|
Abstract
To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.
Collapse
|
39
|
Gastélum-Cano JM, Dautt-Castro M, García-Galaz A, Felix-Murray K, Rascón-Careaga A, Cano-Rangel MA, Islas-Osuna MA. The clinical laboratory evolution in coccidioidomycosis detection: Future perspectives. J Mycol Med 2021; 31:101159. [PMID: 34157512 DOI: 10.1016/j.mycmed.2021.101159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
Coccidioidomycosis is a systemic disease caused by the fungi Coccidioides immitis and C. posadasii. It is a prevalent disease in arid regions with high temperatures and low precipitations in America. Coccidioidomycosis is a highly endemic disease of US-Mexico border states but commonly underdiagnosed. The diagnosis of coccidiomycosis is not easy due to the lack of specific symptoms; it is usually an integral approach, including clinical laboratory tests as an essential part of the diagnosis. Nevertheless, despite various laboratory tests available, affordability can be a limitation, mainly in developing countries. This review's objectives are 1) to learn the different laboratory approaches that arose and their application for clinical diagnosis; 2) to discuss their advantages and weaknesses, and finally, 3) propose what is on the horizon for future advances in clinical laboratory diagnosis of coccidioidomycosis. It has been a long way in laboratory tests evolution to detect coccidioidomycosis from tissue microscopy to Real-Time PCR. However, there is a delay in technology adoption for Coccidioides spp. detection in the clinical laboratory. The molecular Point of Care Testing (POCT) technology has reached us in our trench while research in PCR variants stills on-going. None of the currently existing scientific literature in coccidioidomycosis research has mentioned it. However, this trend in infectious and non-infectious disease diagnosis will continue in that way in order to offer better options for an easy and fast diagnosis. Undoubtedly, the implementation of molecular POCT for Coccidioides spp. would save resources in health care attention and improve access to diagnostic tools.
Collapse
Affiliation(s)
- José María Gastélum-Cano
- Lab. de Genética y Biología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico
| | - Mitzuko Dautt-Castro
- Instituto Potosino de Investigación Científica y Tecnológica A.C. (IPICYT). Camino a la Presa de San José No. 2055. Lomas 4ta Sección, San Luis Potosí, S.L.P. 78216, Mexico
| | - Alfonso García-Galaz
- Lab. de Microbiología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico
| | - Katya Felix-Murray
- Universidad de Sonora. Blvd. Luis Encinas y Rosales S/N. Col. Centro, Hermosillo, Sonora 83000, Mexico
| | - Antonio Rascón-Careaga
- Universidad de Sonora. Blvd. Luis Encinas y Rosales S/N. Col. Centro, Hermosillo, Sonora 83000, Mexico
| | - Manuel A Cano-Rangel
- Hospital Infantil del Estado de Sonora (HIES), Reforma 355. Ley 57, Hermosillo, Sonora 83100, Mexico
| | - María A Islas-Osuna
- Lab. de Genética y Biología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico.
| |
Collapse
|
40
|
Laws RL, Jain S, Cooksey GS, Mohle-Boetani J, McNary J, Wilken J, Harrison R, Leistikow B, Vugia DJ, Windham GC, Materna BL. Coccidioidomycosis outbreak among inmate wildland firefighters: California, 2017. Am J Ind Med 2021; 64:266-273. [PMID: 33484179 PMCID: PMC8935635 DOI: 10.1002/ajim.23218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND In California, state prison inmates are employed to fight wildfires, which involves performing soil-disrupting work. Wildfires have become more common, including areas where Coccidioides, the soil-dwelling fungus that causes coccidioidomycosis, proliferates. However, work practices that place wildland firefighters at risk for coccidioidomycosis have not been investigated. METHODS On August 17, 2017, the California Department of Public Health was notified of a cluster of coccidioidomycosis cases among Wildfire A inmate wildland firefighters. We collected data through medical record abstraction from suspected case-patients and mailed a survey assessing potential job task risk factors to Wildfire A inmate firefighters. We described respondent characteristics and conducted a retrospective case-control investigation to assess coccidioidomycosis risk factors. RESULTS Among 198 inmate firefighters who worked on Wildfire A, 112 (57%) completed the survey. Of 10 case-patients (four clinical and six laboratory-confirmed), two were hospitalized. In the case-control analysis of 71 inmate firefighters, frequently cutting fire lines with a McLeod tool (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 1.1-37.2) and being in a dust cloud or storm (OR: 4.3; 95% CI: 1.1-17.4) were associated with illness. Two of 112 inmate firefighters reported receiving coccidioidomycosis training; none reported wearing respiratory protection on this wildfire. CONCLUSIONS Wildland firefighters who use hand tools and work in dusty conditions where Coccidioides proliferates are at risk for coccidioidomycosis. Agencies that employ them should provide training about coccidioidomycosis and risk reduction, limit dust exposure, and implement respiratory protection programs that specify where respirator use is feasible and appropriate.
Collapse
Affiliation(s)
- Rebecca L. Laws
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- California Department of Public Health, Richmond, California, USA
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA
| | | | | | - Jennifer McNary
- California Department of Public Health, Richmond, California, USA
| | - Jason Wilken
- California Department of Public Health, Richmond, California, USA
- Office of Public Health Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Robert Harrison
- California Department of Public Health, Richmond, California, USA
| | - Bruce Leistikow
- California Correctional Health Care Services, Elk Grove, California, USA
| | - Duc J. Vugia
- California Department of Public Health, Richmond, California, USA
| | - Gayle C. Windham
- California Department of Public Health, Richmond, California, USA
| | | |
Collapse
|
41
|
Abstract
We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.
Collapse
|
42
|
Falk N, Garland S, Wilk A. Less Common Respiratory Conditions: Fungal Respiratory Infections. FP Essent 2021; 502:23-28. [PMID: 33683851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coccidioidomycosis, histoplasmosis, and aspergillosis are all caused by inhaling a soil fungus. Most patients with coccidioidomycosis, which is endemic to California and Arizona, are asymptomatic, but 40% have influenzalike symptoms that frequently resolve without treatment. Rarely, coccidioidomycosis can disseminate. It typically is diagnosed with chest x-ray and antibody tests. Antifungal therapy is only needed for severe infections and individuals with extensive comorbidities. Histoplasmosis is endemic to central/eastern United States. Only 10% of cases are symptomatic, and they typically resolve without treatment. Severe illness can occur in immunocompromised individuals. Diagnosis typically is made with chest x-ray and urine/serum antigen tests. Antifungal therapy is indicated for mild infections that do not resolve and for those with more severe disease. Neither histoplasmosis nor coccidioidomycosis is spread from person to person. Aspergillosis also can be acquired in health care settings via person-to-person spread or contaminated medical devices. Aspergillus-related pulmonary disease includes an allergic syndrome, aspergillomas (fungus balls) in the lungs or sinuses, and chronic or invasive forms. The allergic syndrome is initially diagnosed with skin tests or immunoglobulin E levels and managed with steroids and antifungals. Aspergillomas and invasive disease are initially detected with x-rays and managed with antifungals.
Collapse
Affiliation(s)
- Nathan Falk
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
| | - Scott Garland
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
| | - Ashley Wilk
- Florida State University College of Medicine Family Medicine Residency Program at BayCare Health System, 1201 1st St S Suite 100A, Winter Haven, FL 33880
| |
Collapse
|
43
|
Abstract
Coccidioidomycosis is an endemic mycosis of the southern United States, Northern Mexico, and South America. Primary cutaneous coccidioidomycosis, despite being a very rare clinical presentation, has shown an increasing incidence. An extensive literature search for cutaneous coccidioidomycosis cases was performed using the OLDMEDLINE, PubMed, Cochrane, LILACS and Google Scholar databases for studies published from January 1927 through December 21, 2019. Forty-two observational studies were included totaling 82 cases of primary cutaneous coccidioidomycosis. Narrative reviews, systematic reviews, and meta-analyses were also included. Additionally, an original case was included. Patients with primary cutaneous coccidioidomycosis share the same geographical and epidemiological characteristics as those with pulmonary or disseminated coccidioidomycosis. Most of the imported cases came from endemic areas. A large portion of cases had prior local skin trauma. Tissue culture is still the leading diagnostic method; nevertheless, molecular techniques such as polymerase chain reaction (PCR) are currently relevant to differentiate between species. First-line treatment consists of azoles; however, it has an excellent prognosis even without treatment. Primary cutaneous coccidioidomycosis should be considered a differential diagnosis of unusual infections or neoformations in any part of the body in resident populations of endemic areas or in patients with a previous history of travel to these areas.
Collapse
Affiliation(s)
- Irving Llibran Reyna-Rodríguez
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico
| | - Sonia Chavez-Alvarez
- Dermatology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. Gonzalez", Universidad Autonoma de Nuevo Leon, Nuevo Leon, Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Mexico.
| |
Collapse
|
44
|
Lauer A, Etyemezian V, Nikolich G, Kloock C, Arzate AF, Sadiq Batcha F, Kaur M, Garcia E, Mander J, Kayes Passaglia A. Valley Fever: Environmental Risk Factors and Exposure Pathways Deduced from Field Measurements in California. Int J Environ Res Public Health 2020; 17:ijerph17155285. [PMID: 32707996 PMCID: PMC7432779 DOI: 10.3390/ijerph17155285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/28/2022]
Abstract
Coccidioidomycosis, also known as Valley fever, has been reported among military personnel in Coccidioides-endemic areas of the southwestern United States since World War II. In this study, the prevalence of Coccidioides was confirmed in different soil and dust samples collected near three military bases in California using DNA extraction and Polymerase Chain Reaction (PCR) methods. Analyses of physical and chemical parameters revealed no significant differences between Coccidioides-positive and -negative sites. Soil samples collected in the Mojave Desert (near Twentynine Palms MCAGCC) showed the highest percentage of Coccidioides-positive soil and dust samples. Samples from the San Joaquin Valley (near NAS Lemoore) showed the lowest percentage of positive samples and were restricted to remnants of semi-natural areas between agricultural fields. Our results suggest that soil disturbance around all three military bases investigated poses a potential Coccidioides exposure risk for military personnel and the public. We conclude that once lands have been severely disturbed from their original state, they become less suitable for Coccidioides growth. We propose a conceptual framework for understanding exposure where disturbance of soils that exhibit natural or remnants of native vegetation (Creosote and Salt Bush) generate a high risk of exposure to the pathogen, likely during dry periods. In contrast, Coccidioides-positive sites, when undisturbed, will not pose a high risk of exposure.
Collapse
Affiliation(s)
- Antje Lauer
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
- Correspondence:
| | - Vicken Etyemezian
- Desert Research Institute (DRI), Las Vegas, NV 89119, USA; (V.E.); (G.N.)
| | - George Nikolich
- Desert Research Institute (DRI), Las Vegas, NV 89119, USA; (V.E.); (G.N.)
| | - Carl Kloock
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Angel Franco Arzate
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Fazalath Sadiq Batcha
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Manpreet Kaur
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Eduardo Garcia
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Jasleen Mander
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| | - Alyce Kayes Passaglia
- Department of Biology, California State University Bakersfield (CSUB), Bakersfield, CA 93311-1022, USA; (C.K.); (A.F.A.); (F.S.B.); (M.K.); (E.G.); (J.M.); (A.K.P.)
| |
Collapse
|
45
|
|
46
|
Lauer A, Lopez J, Abarca S, Bains J. Earthquake-Ridden Area in USA Contains Coccidioides, the Valley Fever Pathogen. Ecohealth 2020; 17:248-254. [PMID: 32666206 DOI: 10.1007/s10393-020-01485-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
Early July 2019, two major earthquakes occurred in the Mojave Desert of California near the city of Ridgecrest and the community of Trona and generated a large dust plume that lingered for days. The earthquakes hit an area endemic for Coccidioides, a soil-borne fungal pathogen that can become airborne when soil is disturbed and typically manifests as a pulmonary disease when inhaled. This study is the first to confirm the presence of Coccidioides in soils near Trona using a nested polymerase chain reaction (PCR) approach. First responders to earthquake events, the public, and physicians in the San Joaquin Valley and the Mojave Desert should be informed about the risk of pathogen exposure during and after the time of an earthquake, since there are many fault lines in addition to the large San Andreas Fault and future earthquakes in this region are expected to occur.
Collapse
Affiliation(s)
- Antje Lauer
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA, 93311-1022, USA.
| | - Jocelyne Lopez
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA, 93311-1022, USA
| | - Stephanie Abarca
- Department of Biology, California State University Bakersfield, 9001 Stockdale Highway, Bakersfield, CA, 93311-1022, USA
| | - Jasmeet Bains
- Omni Family Health Clinic, Taft Health Center, 4th Street, Taft, CA, 93268, USA
| |
Collapse
|
47
|
Herrick KR, Trondle ME, Febles TT. Coccidioidomycosis (Valley Fever) in Primary Care. Am Fam Physician 2020; 101:221-228. [PMID: 32053327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Primary pulmonary coccidioidomycosis (valley fever) is caused by inhaling airborne spores of the fungus Coccidioides immitis or Coccidioides posadasii. Residing in or traveling to areas endemic for Coccidioides is required for the diagnosis; no person-to-person or zoonotic contagion occurs. The incidence of coccidioidomycosis is increasing in endemic areas, and it has been identified as the cause of as many as 17% to 29% of all cases of community-acquired pneumonia in some regions. Obtaining a travel history is recommended when evaluating patients with community-acquired pneumonia. Diagnosis usually relies on enzyme immunoassay with immunodiffusion confirmation, but these tests may not be positive for one to three weeks after disease onset. Antifungal agents are not recommended for treatment unless the patient is at risk of or shows signs of complicated or disseminated infection. When antifungals are used, fluconazole and itraconazole are most commonly recommended, except during pregnancy. Treatment may continue for as long as three to 12 months, although lifetime treatment is indicated for patients with coccidioidal meningitis. Monitoring of complement fixation titers and chest radiography is recommended until patients stabilize and symptoms resolve. In patients who are treated with antifungals, complement fixation titers should be followed for at least two years.
Collapse
|
48
|
Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
Collapse
Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
| |
Collapse
|
49
|
Donovan FM, Wightman P, Zong Y, Gabe L, Majeed A, Ynosencio T, Bedrick EJ, Galgiani JN. Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA. Emerg Infect Dis 2020; 25:1745-1747. [PMID: 31441755 PMCID: PMC6711243 DOI: 10.3201/eid2509.190023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.
Collapse
|
50
|
Kollath DR, Miller KJ, Barker BM. The mysterious desert dwellers: Coccidioides immitis and Coccidioides posadasii, causative fungal agents of coccidioidomycosis. Virulence 2019; 10:222-233. [PMID: 30898028 PMCID: PMC6527015 DOI: 10.1080/21505594.2019.1589363] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/07/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023] Open
Abstract
The genus Coccidioides consists of two species: C. immitis and C. posadasii. Prior to 2000, all disease was thought to be caused by a single species, C. immitis. The organism grows in arid to semiarid alkaline soils throughout western North America and into Central and South America. Regions in the United States, with highest prevalence of disease, include California, Arizona, and Texas. The Mexican states of Baja California, Coahuila, Sonora, and Neuvo Leon currently have the highest skin test positive results. Central America contains isolated endemic areas in Guatemala and Honduras. South America has isolated regions of high endemicity including areas of Colombia, Venezuela, Argentina, Paraguay, and Brazil. Although approximately 15,000 cases per year are reported in the United States, actual disease burden is estimated to be in the hundreds of thousands, as only California and Arizona have dedicated public health outreach, and report and track disease reliably. In this review, we survey genomics, epidemiology, ecology, and summarize aspects of disease, diagnosis, prevention, and treatment.
Collapse
Affiliation(s)
- Daniel R. Kollath
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Karis J. Miller
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Bridget M. Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| |
Collapse
|