Coccidioidomycosis In California Research Articles

Coccidioidomycosis seasonality in California: a longitudinal surveillance study of the climate determinants and spatiotemporal variability of seasonal dynamics, 2000–2021

Coccidioidomycosis, an emerging fungal disease in the western USA, exhibits seasonal patterns that are poorly understood, including periods of strong cyclicity, aseasonal intervals, and variation in seasonal timing that have been minimally characterized, and unexplained as to their causal factors. Coccidioidomycosis incidence has increased markedly in recent years, and our limited understanding of intra- and inter-annual seasonality has hindered the identification of important drivers of disease transmission, including climate conditions. In this study, we aim to characterize coccidioidomycosis seasonality in endemic regions of California and to estimate the relationship between drought conditions and coccidioidomycosis seasonal periodicity and timing. We analysed data on all reported incident cases of coccidioidomycosis in California from 2000 to 2021 to characterize seasonal patterns in incidence, and conducted wavelet analyses to assess the dominant periodicity, power, and timing of incidence for 17 counties with consistently high incidence rates. We assessed associations between seasonality parameters and measures of drought in California using a distributed lag nonlinear modelling framework. All counties exhibited annual cyclicity in incidence (i.e., a dominant wavelet periodicity of 12 months), but there was considerable heterogeneity in seasonal strength and timing across regions and years. On average, 12-month periodicity was most pronounced in the Southern San Joaquin Valley and Central Coast. Further, the annual seasonal cycles in the Southern San Joaquin Valley and the Southern Inland regions occurred earlier than those in coastal and northern counties, yet the timing of annual cycles became more aligned among counties by the end of the study period. Drought conditions were associated with a strong attenuation of the annual seasonal cycle, and seasonal peaks became more pronounced in the 1-2 years after a drought ended. We conclude that drought conditions do not increase the risk of coccidioidomycosis onset uniformly across the year, but instead promote increased risk concentrated within a specific calendar period (September to December). The findings have important implications for public health preparedness, and for how future shifts in seasonal climate patterns and extreme events may impact spatial and temporal coccidioidomycosis risk. National Institutes of Health.

Point Process Models for the Spread of Coccidioidomycosis in California.

Coccidioidomycosis is an infectious disease of humans and other mammals that has seen a recent increase in occurrence in the southwestern United States, particularly in California. A rise in cases and risk to public health can serve as the impetus to apply newly developed methods that can quickly and accurately predict future caseloads. The recursive and Hawkes point process models with various triggering functions were fit to the data and their goodness of fit evaluated and compared. Although the point process models were largely similar in their fit to the data, the recursive point process model offered a slightly superior fit. We explored forecasting the spread of coccidioidomycosis in California from December 2002 to December 2017 using this recursive model, and we separated the training and testing portions of the data and achieved a root mean squared error of just 3.62 cases/week.

Sociodemographic factors associated with patients hospitalised for coccidioidomycosis in California and Arizona, State Inpatient Database 2005-2011.

Coccidioidomycosis is endemic in the Southwestern United States. Disseminated infection can be life-threatening and is responsible for hospitalisation and significant healthcare resource utilisation. There are limited data evaluating factors associated with hospitalisation for coccidioidomycosis. We conducted a cross-sectional study to assess incidence and factors associated with coccidioidomycosis-associated hospitalisation in California and Arizona. We analysed hospital discharge data obtained from the State Inpatient Dataset for California and Arizona between 2005 and 2011 and performed multivariable logistic regression examining factors associated with coccidioidomycosis-associated hospitalisation. During our time frame, we found 23 758 coccidioidomycosis-associated hospitalisations. Coccidioidomycosis incidence was over sixfold higher in Arizona compared to California (198.9 vs. 29.6/100 000 person-years). In our multivariable model, coccidioidomycosis-associated hospitalisation was associated with age group 40-49 years (referent group: age 18-29 years, adjusted odds ratio (aOR) = 1.50 (95% confidence interval (CI) 1.43-1.59)), African American race (referent group: Caucasian, aOR = 1.98 (95% CI 1.89-2.06)), residing in a large rural town (referent group: urban area, aOR = 2.28 (95% CI 2.19-2.39)), uncomplicated diabetes (aOR = 1.47 (95% CI 1.41-1.52)) chronic obstructive pulmonary disease (aOR = 1.59 (95% CI 1.54-1.65)) and higher number of comorbidities (aOR = 1.02 (95% CI 1.02-1.03) for each point in the Elixhauser score). Identifying persons at highest risk for hospitalisation with coccidioidomycosis may be helpful for future prevention efforts.

A Review of Coccidioidomycosis in California: Exploring the Intersection of Land Use, Population Movement, and Climate Change.

California has seen a surge in coccidioidomycosis (valley fever), a disease spread by the Coccidioides immitis fungus found in soil throughout the state, particularly in the San Joaquin Valley. We reviewed epidemiologic studies in which outbreak and sporadic cases of coccidioidomycosis were examined, and we considered the possible relationship of these cases to environmental conditions, particularly the state's increasing aridity, drought, and wildfire conditions. Most of the studies we reviewed pertained to cases occupationally acquired in construction, military, archeological, and correctional institutional settings where workers were exposed to dust in C. immitis-endemic areas. A few reviewed outbreaks in the general population related to dust exposure from natural disasters, including an earthquake-associated landslide and a dust storm that carried particles long distances from endemic areas. Although many of California's coccidioidomycosis outbreaks have been occupationally related, changing demographics and new, immunologically naïve populations in dry, endemic areas could expose the general population to C. immitis spores. Given the high rate of infection among workers who, for the most part, are healthy, the general population, including some elderly and immunocompromised individuals, could face additional risk. With climate-related events like drought and wildfires also increasing in endemic areas, research is needed to address the possible associations between these phenomena and coccidioidomycosis outbreaks.

Coccidioidomycosis: What a long strange trip it's been.

The recorded history of coccidioidomycosis began in 1892 with the report of the illness of Domingo Escurra by Alejandro Posadas followed by a description of the first North American cases by Rixford and Gilchrist. Originally considered a protozoan, William Ophüls determined that Coccidioides was a fungus and that the lungs were the apparent initial site of infection. During the 1930s, both Gifford and Dickson determined that a self-limited illness, Valley Fever, was caused by the same fungus that caused the often fatal coccidioidal granuloma. Charles Smith, over a period of approximately 2 decades, comprehensively described the clinical and geographic epidemiology of coccidioidomycosis in California. Demosthenes Pappagianis continued this work after Smith's death. In 1957, one year before Marshall Fiese published his masterful monograph on coccidioidomycosis, the use of the first effective agent for the therapy of coccidioidomycosis, amphotericin B, was reported. This was followed by descriptions of its appropriate clinical use by William Winn and by Hans Einstein, among others. The development of the much less toxic azole antifungal agents greatly simplified therapy in many cases, but much of the management of patients with coccidioidomycosis still relies more on art than science. The search for the “Holy Grail” - a vaccine capable of preventing this disease-continues.

390. Sociodemographic Factors Associated With Patients Hospitalized for Coccidioidomycosis in California and Arizona, State Inpatient Database 2005–2011

BackgroundCoccidioidomycosis is endemic in the Southwestern United States. Disseminated infection can be life-threatening and is responsible for hospitalization and healthcare resource utilization. There are limited data evaluating factors associated with coccidioidomycosis hospitalization.MethodsWe conducted a cross-sectional study to assess sociodemographic and comorbidity factors associated with hospitalization due to coccidioidomycosis in California and Arizona compared with hospitalization for other causes. We analyzed hospital discharge data obtained from the State Inpatient Dataset (SID) for both California and Arizona for years 2005–2011. Multivariable logistic regression modeling was used to analyze factors associated with coccidioidomycosis.ResultsA total of 23,758 hospitalizations due to coccidioidomycosis occurred during the study period in the two states. Arizona had an over six-fold higher coccidioidomycosis hospitalization incidence rate compared with California, 198.9 vs. 29.6/100,000 person-years. In the multivariable model patients aged (40–49) years had a higher odds of hospitalization due to coccidioidomycosis vs. young adults (18–29) years (aOR = 1.50 [95% CI 1.43–1.59]). African Americans had higher odds of hospitalization due to coccidioidomycosis vs. Caucasians (aOR = 1.98 [95% CI 1.89–2.06]). Residing in a large rural town had a higher odds of hospitalization due to coccidioidomycosis vs. residing in an urban area (aOR = 2.28; 95% [CI 2.19–2.39]). Higher comorbidities were associated with an increased odds for hospitalization due to coccidioidomycosis (aOR = 1.02 [95% CI 1.02–1.03]) for each point in the Elixhauser score). Uncomplicated diabetes and chronic pulmonary disease was also associated with hospitalization due to coccidioidomycosis (aOR = 1.47 [95% CI 1.41–1.52] and (aOR = 1.59 [95% CI 1.54–1.65]), respectively.ConclusionWe found sociodemographic factors and comorbidities associated with hospitalizations due to coccidioidomycosis compared with hospitalization due to other causes. Identifying persons at highest risk for hospitalization with coccidioidomycosis may be helpful for future prevention efforts.Disclosures All authors: No reported disclosures.

Risk Factors and Spatial Distribution of Canine Coccidioidomycosis in California, 2005-2013

Given the predisposition of dogs to coccidioidomycosis, identification of high-risk regions for coccidioidomycosis in dogs may improve early recognition of emerging human disease. We sought to identify risk factors for canine coccidioidomycosis and to produce a risk map for coccidioidomycosis occurrence. Forty-one dogs seen at the Veterinary Medical Teaching Hospital at the University of California, Davis, between 2005 and 2013 with coccidioidomycosis were identified together with a control population of 79 dogs. Owners were surveyed about potential risk factors including younger age, digging behaviour, and travel to Arizona or the California central valley. Risk factors were analysed using logistic regression analysis. Outcomes were used to generate a risk map for coccidioidomycosis in California. There was a significant correlation between the reported rate of coccidioidomycosis in humans and our risk map for canine coccidioidomycosis in California, supporting the idea of dogs as sentinels for emerging geographic areas for coccidioidomycosis in humans.

New aspects of some endemic mycoses

The treatment of mycetomas varies according to their etiological agents and the clinical state of the patient. For the treatment of eumycetomas, the azole derivatives are the drugs of choice, with itraconazole rendering better results than ketoconazole and presenting better tolerance. Actinomycetomas are treated according to different therapeutic schemes: dapsone plus sulfamethoxazol-trimethoprim (SMT), and streptomycin or amikacin or amoxicillin plus clavulanic acid. The first therapeutic scheme is very useful in the treatment of Nocardia mycetoma, while the association of amikacin plus SMT is the best treatment for those cases produced by Actinomadura madurae. Ciprofloxacin is a very useful drug for the treatment of actinomycotic mycetomas with bone lesions. Although there are several criteria for evaluating clinical outcome there is no accepted criterion of cure. During the 1990s, there was a remarkable increase in the incidence of coccidioidomycosis in California, USA. An almost ten-fold increase in the number of cases was registered during 1992 and 1993 over the usual incidence. A gradual reduction in coccidioidomycosis cases was observed in the late 1990s. This particular coccidioidomycosis outbreak took place in areas of low endemicity, as well as in those of usual high endemicity. Among the factors believed to have influenced this phenomenon were a drought followed by abundant winter/spring rainfall, increased immigration of susceptible individuals, increase in excavation/construction work and a better diagnosis of the infection, particularly in the last part of the decade. The majority of patients presented the usual clinical manifestations of symptomatic primary infection but an unusual number of cases with acute respiratory failure were observed.

Coccidioidomycosis: a reemerging infectious disease.

Coccidioides immitis, the primary pathogenic fungus that causes coccidioidomycosis, is most commonly found in the deserts of the southwestern United States and Central and South America. During the early 1990s, the incidence of coccidioidomycosis in California increased dramatically. Even though most infections are subclinical or self-limited, the outbreak is estimated to have cost more than $66 million in direct medical expenses and time lost from work in Kern County, California, alone. In addition to the financial loss, this pathogen causes serious and life-threatening disseminated infections, especially among the immunosuppressed, including AIDS patients. This article discusses factors that may be responsible for the increased incidence of coccidioidomycosis (e.g., climatic and demographic changes and the clinical problems of coccidioidomycosis in the immunocompromised) and new approaches to therapy and prevention.

Marked increase in coccidioidomycosis in California can have worldwide implications

Marked increase in coccidioidomycosis in California can have worldwide implications

Coccidioidomycosis in California: Regional Outbreak, Global Diagnostic Challenge

Beginning in 1991, case reports of coccidioidomycosis in California increased dramatically, pursuant to a variety of natural and demographic factors. This highly infectious fungal disease with propensity to disseminate widely, mimic other conditions, and cause pathology at locations distant in place and time is readily treatable if recognized at an early stage. The concentration of military bases in endemic areas and the mobility of military personnel suggest a heightened potential for case presentations elsewhere and a need for elevated diagnostic suspicion on the part of military physicians worldwide. We review three cases of disseminated disease recently referred to our facility.

Characterization of Coccidioides immitis isolates by restriction fragment length polymorphisms

The marked increase in the number of cases of coccidioidomycosis in California in 1992 led to a study of isolates from various patients and environmental sources by restriction fragment length polymorphism (RFLP) analysis. Of 15 different isolates, most of the isolates (13 of 15) from California and 1 from Venezuela yielded one main RFLP pattern with evidence of two subgroups. The other two isolates (both from patients in the San Joaquin Valley of California) yielded a different RFLP pattern.

Marked Increase in Cases of Coccidioidomycosis in California: 1991, 1992, and 1993

Coccidioidomycosis is endemic in California. In an 11-year period from the beginning of 1980 to the end of 1990, an average of approximately 400-500 cases per year were reported to the California State Department of Health Services (CSDHS). In 1990, 441 cases were reported. However, a striking increase in the number of cases was noted in 1991, 1992, and 1993, particularly in the southern San Joaquin Valley counties of Kern and Tulare. In 1992, striking increases were noted in other counties as well. In California there were 1,200 and 4,541 new cases in 1991 and 1992, respectively, that were reported to the CSDHS. The usual rate (5%-7%) of metapulmonary dissemination was noted in these outbreaks, and cases resembling acute adult respiratory distress syndrome that had been noted infrequently in previous outbreaks were conspicuous among the 1991 and 1992 cases. Factors thought to contribute to the extraordinary increases in coccidioidomycosis were a drought of 5 to 6 years' duration; abundant rain in March 1991 and February-March 1992; construction of new buildings; and arrival of new, susceptible individuals to the areas of endemicity.