So, if I travel to "Venezuela", can I get coccidioidomycosis?

Abstract

Sir, We read with great interest the case report published by Corpolongo et al. [1]. These authors described a case of pulmonary coccidioidomycosis in an Italian traveler who visited Venezuela. We agree on the importance of considering Coccidioides infection in patients coming from known endemic areas. But having some specific areas of country endemic does not necessarily implies that the whole country should be considered as such. This is currently highly relevant to infectious diseases and travel medicine practitioners. This is similar to saying that a patient who traveled to the United States of America (USA) (e.g., New York) should be considered as having visited an ‘‘endemic country’’ for coccidioidomycosis, given the fact that most cases of coccidioidomycosis occur in the southwestern states of the USA (especially, Arizona and California). Even when widely endemic in a country, there is great variability in the incidence and such description ‘‘he had travelled to Venezuela’’, is inaccurate [2, 3]. In tropical countries, such as Venezuela, the epidemiology of infectious diseases dramatically varies by geographic location of the patient and the places where he would be exposed, and this includes coccidioidomycosis [4]. Coccidioidomycosis is a fungal infection acquired by exposure to contaminated dust and is limited to regions with defined eco-environmental conditions, such as desert areas with semi-arid climates, low altitude, xerophytic vegetation, sandy soils and alkaline pH (these are not the conditions of the major cities in Venezuela). This fungal infection has been found only in the Western Hemisphere, predominantly in southern areas of USA [Arizona (73.5 % of USA cases reported in 2011), California, Nevada, New Mexico, Utah and Texas], and in some areas of certain South American countries such as Venezuela, Mexico, Argentina, Paraguay, Colombia and possibly Bolivia, Peru and Ecuador [4, 5]. In Venezuela, although fungal infections are not under surveillance, epidemiological studies have identified only three states (out of 24 of the country) with risk and human cases reported so far: Falcon, Zulia and Lara (rural areas) (western region of the country) (Fig. 1) [4, 5]. As noted, coccidioidomycosis is a rare mycosis prevalent in just some states of Venezuela, mainly restricted to dry areas of north-west of the country. It would be interesting to know in which specific area of the country was the patient reported by Corpolongo et al. Discussion about the epidemiology in other countries has been described, but not with regard to the country where their patient ‘‘acquired’’ this fungal infection. We noted that the reported case presented clinical signs and symptoms most frequently observed in this fungal infection [3], consistent with some reports that have indicated an increased susceptibility of travelers to endemic areas, but as many as 70 % of cases would be asymptomatic or with mild symptoms [2]. Besides the long duration of treatment in this patient, some of the series have suggested more effective antifungals such as amphotericin B or newer azoles [1–3]. It is A. J. Rodriguez-Morales (&) C. E. Jimenez-Canizales A. Mondragon-Cardona Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, UniversidadTecnologica de Pereira, Pereira 660001, Risaralda, Colombia e-mail: ajrodriguezmmd@gmail.com