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Janis E Blair - One of the best experts on this subject based on the ideXlab platform.

  • Coccidioidomycosis in selected immunosuppressed hosts
    Medical Mycology, 2019
    Co-Authors: Janis E Blair, Neil M Ampel, Susan E Hoover
    Abstract:

    After contracting Coccidioidomycosis, persons with impaired cellular immunity are more likely than healthy persons to have severe infection, disseminated infection, and higher mortality rates. In this brief review, we summarize the clinical manifestations, diagnosis, treatment, and prevention of Coccidioidomycosis in persons infected with human immunodeficiency virus (HIV), recipients of solid organ or hematopoietic stem cell transplants, and recipients of biologic response modifiers. Among individuals infected with HIV, a diagnosis of acquired immunodeficiency syndrome (AIDS) and a CD4 T-lymphocyte count <250 cells/μl were associated with more severe Coccidioidomycosis, whereas less severe disease occurred among those with undetectable HIV-RNA and higher CD4 T-lymphocyte counts, indicating that controlled HIV viremia and improved cellular immune status are important in limiting disease. For transplant recipients whose immunosuppression typically peaks in the first 3 to 6 months and tapers thereafter, the greatest risk of acute Coccidioidomycosis occurs 6 to 12 months after transplantation. Relapses of recent Coccidioidomycosis may occur during ongoing immunosuppression when patients are not taking suppressive antifungal medication. Recipients of biologic agents, especially those that impair tumor necrosis factor α (TNF-α), may be at increased risk for poorly controlled Coccidioidomycosis; however, the best way to prevent and treat such infections has yet to be defined.

  • Divergence in the approach to tumor necrosis factor α-inhibitor recipients with Coccidioidomycosis
    Infection, 2017
    Co-Authors: Ashley L. Garrett, Elizabeth Wack, Janis E Blair
    Abstract:

    Background Tumor necrosis factor α-inhibitors (TNFIs) have been associated with increased risk of certain fungal infections, including Coccidioidomycosis. The optimal treatment approach to Coccidioidomycosis in TNFI recipients is unknown. Methods We constructed an anonymous, voluntary survey for practicing pulmonary and infectious disease physicians in the state of Arizona regarding approach to TNFI patients with Coccidioidomycosis. Results There is no current consensus on managing these patients. Conclusions Further research is necessary to determine the optimal approach to TNFI recipients with Coccidioidomycosis.

  • Coccidioidomycosis in Patients with Selected Solid Organ Cancers: A Case Series and Review of Medical Literature
    Mycopathologia, 2016
    Co-Authors: Colin Fitterer, Holenarasipur R Vikram, Shimon Kusne, Maria Teresa Seville, Zachary Berg, Thorvardur R. Halfdanarson, Robert Orenstein, Janis E Blair
    Abstract:

    Coccidioidomycosis is a common infection in the desert southwestern USA; approximately 3 % of healthy persons in Arizona alone become infected annually. Coccidioidomycosis may be severe in immunocompromised persons, but experience among patients with solid organ cancer has not been fully described. Therefore, we aimed to describe the clinical courses of patients whose cancers were complicated by Coccidioidomycosis at our institution, which is located in an area with endemic Coccidioides . To do so, we conducted a retrospective review from January 1, 2000, through December 31, 2014, of all patients with breast, colorectal, or ovarian cancer whose cancer courses were complicated by Coccidioidomycosis. We identified 17,576 cancer patients; 14 (0.08 %) of these patients met criteria for proven or probable Coccidioidomycosis diagnosed within the first 2 years after the cancer diagnosis. All of these patients had primary pulmonary Coccidioidomycosis, none had relapsed prior infection, and 1 had possible extrapulmonary dissemination. Five had active coccidioidal infection during chemotherapy, 1 of whom was hospitalized for coccidioidal pneumonia. All were treated with fluconazole, and all improved clinically. Eleven did not require prolonged courses of fluconazole. There were no clearly demonstrated episodes of relapsed infection. In conclusion, Coccidioidomycosis was not a common complication of breast, colorectal, or ovarian cancers in patients treated at our institution, and it was not commonly complicated by severe or disseminated infection.

  • Treatment considerations in pulmonary Coccidioidomycosis.
    Expert review of respiratory medicine, 2016
    Co-Authors: Carlos A. Hartmann, Wint T. Aye, Janis E Blair
    Abstract:

    ABSTRACTIntroduction: Coccidioidomycosis is an endemic fungal infection caused by the soil-dwelling fungi, Coccidioides species. Coccidioidal infections may be asymptomatic in up to two-thirds of infected persons. Pulmonary Coccidioidomycosis is the most common form of symptomatic infection. Fluconazole is the antifungal agent typically used to treat pulmonary Coccidioidomycosis. Other azoles and amphotericin B products may be prescribed to treat nuanced aspects of Coccidioidomycosis.Areas covered: This review discusses current literature regarding medical treatment options, including the various triazoles and amphotericin B products. In addition, we discuss uncomplicated and complicated pulmonary infections and their sequelae and the approach to managing Coccidioidomycosis in certain populations of patients, such as pregnant women, transplant recipients, individuals infected with human immunodeficiency virus, and recipients of tumor necrosis factor-α inhibitors.Expert commentary: Symptomatic coccidioidom...

  • Chronic interstitial granulomatous dermatitis in Coccidioidomycosis.
    The British journal of dermatology, 2016
    Co-Authors: Aaron R. Mangold, Janis E Blair, David J. Dicaudo, Aleksandar Sekulic
    Abstract:

    Coccidioides species are soil-dwelling fungi endemic to the Southwest U.S.A., especially Arizona and California and Northern Mexico. The cutaneous findings of Coccidioidomycosis have a wide range of pathology, which includes organism-specific and reactive processes. Interstitial granulomatous dermatitis (IGD), a granuloma annulare-like reaction, has been described, in a limited form, in association with acute pulmonary Coccidioidomycosis. We present a case of chronic, widespread IGD spanning over 9 years in association with an active Coccidioidomycosis infection. Similar clinical and histopathological features have been described in association with drug reactions, connective tissue diseases, systemic vasculitis, lymphomas, other infectious diseases and inflammatory bowel disease. Our patient's dramatic presentation and chronic course expands upon the clinical spectrum of IGD occurring in association with pulmonary Coccidioidomycosis. While IGD in association with Coccidioidomycosis is rare, both dermatologists and general practitioners see IGD reactions, and our case highlights the importance of identifying the underlying driver.

Neil M Ampel - One of the best experts on this subject based on the ideXlab platform.

  • Coccidioidomycosis in selected immunosuppressed hosts
    Medical Mycology, 2019
    Co-Authors: Janis E Blair, Neil M Ampel, Susan E Hoover
    Abstract:

    After contracting Coccidioidomycosis, persons with impaired cellular immunity are more likely than healthy persons to have severe infection, disseminated infection, and higher mortality rates. In this brief review, we summarize the clinical manifestations, diagnosis, treatment, and prevention of Coccidioidomycosis in persons infected with human immunodeficiency virus (HIV), recipients of solid organ or hematopoietic stem cell transplants, and recipients of biologic response modifiers. Among individuals infected with HIV, a diagnosis of acquired immunodeficiency syndrome (AIDS) and a CD4 T-lymphocyte count <250 cells/μl were associated with more severe Coccidioidomycosis, whereas less severe disease occurred among those with undetectable HIV-RNA and higher CD4 T-lymphocyte counts, indicating that controlled HIV viremia and improved cellular immune status are important in limiting disease. For transplant recipients whose immunosuppression typically peaks in the first 3 to 6 months and tapers thereafter, the greatest risk of acute Coccidioidomycosis occurs 6 to 12 months after transplantation. Relapses of recent Coccidioidomycosis may occur during ongoing immunosuppression when patients are not taking suppressive antifungal medication. Recipients of biologic agents, especially those that impair tumor necrosis factor α (TNF-α), may be at increased risk for poorly controlled Coccidioidomycosis; however, the best way to prevent and treat such infections has yet to be defined.

  • THE TREATMENT OF Coccidioidomycosis.
    Revista do Instituto de Medicina Tropical de Sao Paulo, 2015
    Co-Authors: Neil M Ampel
    Abstract:

    Therapy of Coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of Coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of Coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. Individuals with suppressed cellular immunity are at increased risk for symptomatic Coccidioidomycosis and they include those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant. Pregnant women and African-American men have been identified as two other groups who are at an increased risk for symptomatic and severe infection.

  • management of Coccidioidomycosis in patients receiving biologic response modifiers or disease modifying antirheumatic drugs
    Arthritis Care and Research, 2012
    Co-Authors: Sara Taroumian, Neil M Ampel, John N Galgiani, Jeffrey R Lisse, Susan L Knowles, James Yanes, Austin Vaz, Susan E Hoover
    Abstract:

    Objective Coccidioidomycosis (valley fever) is an endemic fungal infection of the American Southwest, an area with a large population of patients with rheumatic diseases. There are currently no guidelines for management of patients who develop Coccidioidomycosis while under treatment with biologic response modifiers (BRMs) or disease-modifying antirheumatic drugs (DMARDs). We conducted a retrospective study of how both concurrent diseases were managed and the patient outcomes at 2 centers in Tucson, Arizona. Methods A retrospective chart review identified patients who developed Coccidioidomycosis during treatment with DMARDs or BRMs. Patients were seen at least once in a university-affiliated or Veterans Affairs outpatient rheumatology clinic in Tucson, Arizona, between 2007 and 2009. Results Forty-four patients were identified. Rheumatologic treatment included a BRM alone (n = 11), a DMARD alone (n = 8), or combination therapy (n = 25). Manifestations of Coccidioidomycosis included pulmonary infection (n = 29), disseminated disease (n = 9), and asymptomatic positive coccidioidal serologies (n = 6). After the diagnosis of Coccidioidomycosis, 26 patients had BRMs and DMARDs stopped, 8 patients had BRMs stopped but DMARD therapy continued, and 10 patients had no change in their immunosuppressive therapy. Forty-one patients had antifungal therapy initiated for 1 month or longer. Followup data were available for 38 patients. BRM and/or DMARD therapy was continued or resumed in 33 patients, only 16 of whom continued concurrent antifungal therapy. None of the patients have had subsequent dissemination or complications of Coccidioidomycosis. Conclusion Re-treating rheumatic disease patients with a BRM and/or a DMARD after Coccidioidomycosis appears to be safe in some patients. We propose a management strategy based on Coccidioidomycosis disease activity.

  • Coccidioidomycosis during pregnancy a review and recommendations for management
    Clinical Infectious Diseases, 2011
    Co-Authors: Robert Bercovitch, Neil M Ampel, Antonino Catanzaro, Demosthenes Pappagianis, Brian S Schwartz, Heather D Watts
    Abstract:

    Pregnancy is an established risk factor for the development of severe and disseminated Coccidioidomycosis, particularly when infection is acquired during the later stages of gestation. Although recent studies suggest that the incidence of symptomatic Coccidioidomycosis during pregnancy is decreasing and that outcome has improved, management is complicated by the observations that azole antifungal agents can be teratogenic when given to some women, particularly at high doses, early in pregnancy. This article summarizes the data on these issues and offers guidance on the management of Coccidioidomycosis during pregnancy.

  • Coccidioidomycosis in patients with hiv 1 infection in the era of potent antiretroviral therapy
    Clinical Infectious Diseases, 2010
    Co-Authors: Fares Y Masannat, Neil M Ampel
    Abstract:

    BACKGROUND Coccidioidomycosis is a common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected individuals living in regions where Coccidioidomycosis is endemic. However, there have been no studies on its incidence or clinical expression during the era of potent antiretroviral therapy. METHODS Clinical data were abstracted from the records of all HIV-1-infected patients attending a single clinic in a region where Coccidioidomycosis is endemic from January 2003 through May 2008. Additional follow-up was performed through May 2009 for individuals with active Coccidioidomycosis. A case-control study was performed that compared all individuals who attended the clinic with individuals who received a diagnosis of Coccidioidomycosis. RESULTS Among 257 HIV-1-infected patients seen over a 64-month period, 29 cases (11.3%) of Coccidioidomycosis were identified. Twelve patients (4.7%) received a diagnosis of Coccidioidomycosis during the study period (annual incidence, 0.9%). Patients with less severe Coccidioidomycosis were significantly more likely to have an undetectable HIV RNA level and to be receiving potent antiretroviral therapy than were those with more severe disease (for both, P< .01). Five patients with Coccidioidomycosis received no antifungal therapy, and 11 others had antifungal therapy discontinued. All were healthy during follow-up. Patients with Coccidioidomycosis had significantly lower CD4 T lymphocyte counts than did control subjects (mean +/- standard deviation, 285 +/- 42 cells/microL vs 477 +/- 21 cells/microL; P= .003). CONCLUSIONS The incidence of symptomatic Coccidioidomycosis in the era of potent antiretroviral therapy has decreased, and its clinical expression is less severe than it was before the potent antiretroviral therapy era. Severity of Coccidioidomycosis was inversely associated with control of HIV-1 infection.

Emily Blodget - One of the best experts on this subject based on the ideXlab platform.

  • Coccidioidomycosis in solid organ transplant recipients.
    Current opinion in organ transplantation, 2019
    Co-Authors: Deepa Nanayakkara, Emily Blodget
    Abstract:

    Purpose of review The purpose of the review is an update of diagnosis and treatment of Coccidioidomycosis infection in solid organ transplant (SOT) patients. Endemic fungal infections continue to be a cause of serious morbidity and mortality in transplant recipients. Recent findings In transplant patients there are recommendations regarding screening in areas that are endemic for Coccidioidomycosis. This screening involves serologic testing and chest imaging. In endemic areas pretransplant seropositivity varies from 1.4 to 5.6%. In immunocompromised patients with elevated complement fixation titers, evaluation of cerebrospinal fluid is recommended even in the absence of symptoms. Although Coccidioidomycosis can be a self-limited disease in immunocompotent patients, all SOT patients should be treated regardless of severity. This may include intravenous amphotericin B in severe cases and fluconazole therapy in milder episodes. In those SOT recipients with evidence of prior Coccidioidomycosis, lifelong secondary prophylaxis with fluconazole given risk of recurrent disease. Summary Coccidioidomycosis continues to be a cause of serious morbidity and mortality in transplant recipients but with proper screening and treatment can be successfully managed.

  • donor derived coccidioides immitis fungemia in solid organ transplant recipients
    Transplant Infectious Disease, 2012
    Co-Authors: Emily Blodget, Jan P Geiseler, R A Larsen, Maria Stapfer, Y Qazi, L M Petrovic
    Abstract:

    : We report disseminated Coccidioidomycosis in 3 transplant recipients from a donor in an endemic area found to have unrecognized meningeal Coccidioidomycosis. All 3 transplant recipients presented within 3 weeks of receipt of their organ. Only 1 organ recipient survived the acute presentation of Coccidioidomycosis. Serologic testing for Coccidioides immitis infection should be considered for organ donors residing in endemic areas.

Demosthenes Pappagianis - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of the protective efficacy of the killed coccidioides immitis spherule vaccine in humans
    The American review of respiratory disease, 2012
    Co-Authors: Demosthenes Pappagianis
    Abstract:

    A vaccine consisting of formaldehyde-killed spherules of Coccidioides immitis, previously shown to provide protection against development of lethal Coccidioidomycosis in laboratory animals, was evaluated in humans. This double blind “Phase 3” study, conducted during the period 1980 to 1985, involved 2, 867 healthy subjects with no history of Coccidioidomycosis and negative skin tests. Randomized into vaccine (n = 1, 436) or placebo (n = 1, 431) groups, the former received three intramuscular injections of 1.75 mg (dry weight) of spherules, the latter received three injections of sterile 0.85% NaCl solution. Compatible clinical presentation with cultural or serologie findings permitted detection of Coccidioidomycosis. Of those receiving vaccine, nine developed Coccidioidomycosis and nine additional were suspected of having the disease. Of the group receiving placebo, 12 developed Coccidioidomycosis, and 13 additional were suspected of having the disease. All cases and suspected cases were mild. Under the c...

  • Coccidioidomycosis during pregnancy a review and recommendations for management
    Clinical Infectious Diseases, 2011
    Co-Authors: Robert Bercovitch, Neil M Ampel, Antonino Catanzaro, Demosthenes Pappagianis, Brian S Schwartz, Heather D Watts
    Abstract:

    Pregnancy is an established risk factor for the development of severe and disseminated Coccidioidomycosis, particularly when infection is acquired during the later stages of gestation. Although recent studies suggest that the incidence of symptomatic Coccidioidomycosis during pregnancy is decreasing and that outcome has improved, management is complicated by the observations that azole antifungal agents can be teratogenic when given to some women, particularly at high doses, early in pregnancy. This article summarizes the data on these issues and offers guidance on the management of Coccidioidomycosis during pregnancy.

  • False-Positive IgM Serology in Coccidioidomycosis
    Journal of clinical microbiology, 2010
    Co-Authors: Tim Kuberski, Judith Herrig, Demosthenes Pappagianis
    Abstract:

    The clinical observation has been made that there might be an unacceptable number of false-positive enzyme immunoassay (EIA) test results for IgM among persons suspected of having Coccidioidomycosis. Patients with a positive result for IgM by EIA are thought to have a diagnosis of acute Coccidioidomycosis. However, this study found that 82% of patients with an IgM-positive and IgG-negative EIA result did not have Coccidioidomycosis.

  • donor related Coccidioidomycosis in organ transplant recipients
    Clinical Infectious Diseases, 2003
    Co-Authors: Patty W Wright, Demosthenes Pappagianis, Kenneth Komatsu, Mark Wilson, Ana Paula Louro, Stephen A Moser, Peter G Pappas
    Abstract:

    Most cases of Coccidioidomycosis in organ transplant recipients arise from either primary infection with Coccidioides immitis after environmental exposure or from reactivation of latent infection. Herein, we report 2 cases of rapidly fatal, disseminated Coccidioidomycosis that occurred in organ transplant recipients who had never lived in or visited an area where C. immitis is endemic. Both subjects had received a transplanted organ from the same donor, an individual with unrecognized active Coccidioidomycosis at the time of his death.

  • in vitro whole blood analysis of cellular immunity in patients with active Coccidioidomycosis by using the antigen preparation t27k
    Clinical and Vaccine Immunology, 2002
    Co-Authors: Neil M Ampel, Larissa A Kramer, Deborah S Carroll, K M Kerekes, Suzanne M Johnson, Demosthenes Pappagianis
    Abstract:

    Measurement of cellular immunity in human Coccidioidomycosis has important diagnostic and prognostic implications. The coccidioidin skin test has been the standard for the measurement of this, but it is not available in the United States. We examined the utility of measuring surface expression of CD69 on T lymphocytes in whole blood incubated with the coccidioidal antigen preparation T27K as an alternative to the skin test. Seventy donors with active Coccidioidomycosis were studied. The mean fluorescent intensity (MFI) of CD69 expression on CD3 lymphocytes in response to T27K was 28.61 ± 1.77, significantly greater than the control response of 11.45 ± 0.78 (P < 0.001). The MFI CD69 response to T27K above that for the control (MFI CD69 above control) was 6.35 ± 2.18 for seven subjects with disseminated Coccidioidomycosis who were studied within 5 months of diagnosis. This was significantly below the value of 20.17 ± 3.17 for 18 subjects with pulmonary Coccidioidomycosis studied within 5 months of diagnosis and the value of 19.58 ± 2.91 for 27 subjects with disseminated Coccidioidomycosis studied after 5 months of diagnosis (for both, P < 0.05). There was an inverse correlation between coccidioidal clinical score and MFI CD69 above control for all 34 subjects with disseminated Coccidioidomycosis (r = 0.362; P = 0.036) but not for the 36 subjects with pulmonary disease (r < 0.001; P = 0.993). Among 30 subjects for whom data were available, there was a highly significant association between the MFI CD69 above control and the supernatant concentrations of gamma interferon, interleukin-2 (IL-2), and tumor necrosis factor alpha (for all, P < 0.001), but not for IL-4, IL-5, or IL-10. These data indicate that in vitro assessment of CD69 expression on T lymphocytes by using T27K may be a useful measure of cellular immune response among subjects with active Coccidioidomycosis.

Kaitlin Benedict - One of the best experts on this subject based on the ideXlab platform.

  • update on the epidemiology of Coccidioidomycosis in the united states
    Medical Mycology, 2019
    Co-Authors: Orion Mccotter, Ken Komatsu, Kimberley D Lucas, Janet C Mohleboetani, Duc J Vugia, Kaitlin Benedict, Tom Chiller, David M. Engelthaler, Hanna N Oltean, Gail Sondermeyer L Cooksey
    Abstract:

    The incidence of reported Coccidioidomycosis in the past two decades has increased greatly; monitoring its changing epidemiology is essential for understanding its burden on patients and the healthcare system and for identifying opportunities for prevention and education. We provide an update on recent Coccidioidomycosis trends and public health efforts nationally and in Arizona, California, and Washington State. In Arizona, enhanced surveillance shows that Coccidioidomycosis continues to be associated with substantial morbidity. California reported its highest yearly number of cases ever in 2016 and has implemented interventions to reduce Coccidioidomycosis in the prison population by excluding certain inmates from residing in prisons in high-risk areas. Coccidioidomycosis is emerging in Washington State, where phylogenetic analyses confirm the existence of a unique Coccidioides clade. Additional studies of the molecular epidemiology of Coccidioides will improve understanding its expanding endemic range. Ongoing public health collaborations and future research priorities are focused on characterizing geographic risk, particularly in the context of environmental change; identifying further risk reduction strategies for high-risk groups; and improving reporting of cases to public health agencies.

  • enhanced surveillance for Coccidioidomycosis 14 us states 2016
    Emerging Infectious Diseases, 2018
    Co-Authors: Kaitlin Benedict, Malia Ireland, Meghan Pearce Weinberg, Randon J Gruninger, Jenna Weigand, Lei Chen, Katharine Perezlockett, Catherine Bledsoe, Lynn Denny, Katie Cibulskas
    Abstract:

    Although Coccidioidomycosis in Arizona and California has been well-characterized, much remains unknown about its epidemiology in states where it is not highly endemic. We conducted enhanced surveillance in 14 such states in 2016 by identifying cases according to the Council of State and Territorial Epidemiologists case definition and interviewing patients about their demographic characteristics, clinical features, and exposures. Among 186 patients, median time from seeking healthcare to diagnosis was 38 days (range 1-1,654 days); 70% had another condition diagnosed before Coccidioidomycosis testing occurred (of whom 83% were prescribed antibacterial medications); 43% were hospitalized; and 29% had culture-positive Coccidioidomycosis. Most (83%) patients from nonendemic states had traveled to a Coccidioidomycosis-endemic area. Coccidioidomycosis can cause severe disease in residents of non-highly endemic states, a finding consistent with previous studies in Arizona, and less severe cases likely go undiagnosed or unreported. Improved Coccidioidomycosis awareness in non-highly endemic areas is needed.

  • Coccidioidomycosis outbreaks united states and worldwide 1940 2015
    Emerging Infectious Diseases, 2018
    Co-Authors: Michael Freedman, Brendan R. Jackson, Orion Mccotter, Kaitlin Benedict
    Abstract:

    Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of Coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 Coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940-2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of Coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public.

  • Coccidioidomycosis Outbreaks, United States and Worldwide, 1940–2015
    Centers for Disease Control and Prevention, 2018
    Co-Authors: Michael Freedman, Brendan R. Jackson, Orion Mccotter, Kaitlin Benedict
    Abstract:

    Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of Coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 Coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940–2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of Coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public