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.
Highlights
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 a description of the epidemiology of coccidioidomycosis in Utah and explore environmental and climatic factors contributing to regional variations in statewide incidence using data from cases reported to the Utah Department of Health (UDOH) during 2009–2015
We considered cases proven if they met ≥1 of the following requirements: histopathologic, cytopathologic, or direct microscopic evidence of Coccidioides spherules with tissue damage from sterile specimen or tissue biopsy; culture from any specimen or tissue biopsy positive for C. immitis or C. posadasii; positive blood culture for C. immitis or C. posadasii; positive Coccidioides serology in cerebrospinal fluid; or 2-dilution rise in Coccidioides complement fixation (CF) titer measured in consecutive blood samples tested concurrently
Summary
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. 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. On the basis of findings from the seminal 1957 seropositivity survey [3] that established the com-
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