Surveillance of Coccidioidomycosis, Arizona | CDC EID

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Volume 16, Number 11–November 2010
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Enhanced Surveillance of Coccidioidomycosis, Arizona, USA, 2007–2008

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Surveillance of Coccidioidomycosis, Arizona | CDC EID


EID Journal Home > Volume 16, Number 11–November 2010
Volume 16, Number 11–November 2010
Research
Enhanced Surveillance of Coccidioidomycosis, Arizona, USA, 2007–2008

Clarisse A. Tsang, Comments to Author Shoana M. Anderson, Sara B. Imholte, Laura M. Erhart, Sanny Chen, Benjamin J. Park, Cara Christ, Kenneth K. Komatsu, Tom Chiller, and Rebecca H. Sunenshine
Author affiliations: Arizona Department of Health Services, Phoenix, Arizona, USA (C.A. Tsang, S.M. Anderson, S.B. Imholte, L.M. Erhart, S. Chen, C. Christ, K.K. Komatsu, R.H. Sunenshine); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Chen, B.J. Park, T. Chiller, R.H. Sunenshine)

Suggested citation for this article

Abstract
Coccidioidomycosis is endemic to the southwestern United States; 60% of nationally reported cases occur in Arizona. Although the Council of State and Territorial Epidemiologists case definition for coccidioidomycosis requires laboratory and clinical criteria, Arizona uses only laboratory criteria. To validate this case definition and characterize the effects of coccidioidomycosis in Arizona, we interviewed every tenth case-patient with coccidioidomycosis reported during January 2007–February 2008. Of 493 patients interviewed, 44% visited the emergency department, and 41% were hospitalized. Symptoms lasted a median of 120 days. Persons aware of coccidioidomycosis before seeking healthcare were more likely to receive an earlier diagnosis than those unaware of the disease (p = 0.04) and to request testing for Coccidioides spp. (p = 0.05). These findings warrant greater public and provider education. Ninety-five percent of patients interviewed met the Council of State and Territorial Epidemiologists clinical case definition, validating the Arizona laboratory-based case definition for surveillance in a coccidiodomycosis-endemic area.

Coccidioidomycosis, or valley fever, is a fungal disease endemic to the southwestern United States, parts of Mexico, and Central and South America. Infection probably occurs when arthroconidia from disrupted soil are inhaled, causing lung infection (1,2). Signs and symptoms occur 1–4 weeks after exposure and can include fever, cough, fatigue, shortness of breath, headache, joint and muscle aches, and rash. Coccidioides spp. can spread to the central nervous system, skin, joints, or bones in <1% of those infected, resulting in extrathoracic dissemination (3,4). Each year, an estimated 150,000 persons in the United States become infected with Coccidioides spp., and ≈50,000 of these become ill (5). Most cases are not reported to health departments, resulting in an underestimated number of coccidioidomycosis cases (6). In 2006 in the United States, 8,917 coccidioidomycosis cases were reported, with 5,535 cases reported in Arizona (7). The number of reported coccidioidomycosis cases in Arizona began to increase in 1990. From 1990 through 1995, the annual number of reported coccidioidomycosis cases increased from 255 (7/100,000 population) to 623 (15/100,000 population) (8). This increase led the Arizona Department of Health Services (ADHS) to change its reporting rules to make coccidioidomycosis a laboratory-reportable illness in 1997. Since laboratory reporting became mandatory, coccidioidomycosis case reports have rapidly increased in Arizona. In 2006, the number of cases peaked at 5,535 cases (89/100,000 population) and decreased to 4,815 cases (75/100,000 population) in 2007 and to 4,768 cases (73/100,000 population) in 2008. During 2006–2008 in Arizona, the median age of patients with coccidioidomycosis was 52 years (mean 51 years). Fifty-four percent of patients with coccidioidomycosis were male (84/100,000 population), and 46% were female (72/100,000 population). The Council of State and Territorial Epidemiologists (CSTE) and the Centers for Disease Control and Prevention require laboratory and clinical criteria to meet the case definition for coccidioidomycosis. The laboratory criteria consist of culture, histopathologic, or molecular evidence; or immunologic evidence in the form of detection of immunoglobulin M or immunoglobulin G by immunodiffusion, enzyme immunoassay, latex agglutination, tube precipitin, or complement fixation. Clinical criteria require influenza-like signs and symptoms; pneumonia or other pulmonary lesion; erythema nodosum or erythema multiform rash; involvement of bones, joints, or skin by dissemination; meningitis; or involvement of viscera and lymph nodes (9). Because of Arizona's large number of cases, ADHS uses only the laboratory component of the CSTE case definition. In 2007, ADHS initiated enhanced coccidioidomycosis surveillance (which included patient interviews) to validate a laboratory-exclusive case definition for coccidioidomycosis and to characterize the effects of the disease on Arizona's population, healthcare system, and economy. The purpose of this study was to validate this case definition and characterize the effects of coccidioidomycosis in Arizona during January 2007–February 2008. full-text: Surveillance of Coccidioidomycosis, Arizona | CDC EID

Suggested Citation for this Article

Tsang CA, Anderson SM, Imholte SB, Erhart LM, Chen S, Park BJ, et al. Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007–2008. Title. Emerg Infect Dis [serial on the Internet]. 2010 Nov [date cited]. Available from http://www.cdc.gov/EID/content/16/11/1738.htm

DOI: 10.3201/eid1611.100475