Coccidioidomycosis-associated Deaths, United States, 1990–2008 - - Emerging Infectious Disease journal - CDC
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Coccidioidomycosis-associated Deaths, United States, 1990–2008
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Abstract
Coccidioidomycosis is endemic to the Americas; however, data on deaths caused by this disease are limited. To determine the rate of coccidioidomycosis-associated deaths in the United States, we examined multiple cause–coded death records for 1990–2008 for demographics, secular trends, and geographic distribution. Deaths were identified by International Classification of Diseases, 9th and 10th Revision, codes, and mortality rates were calculated. Associations of deaths among persons with selected concurrent conditions were examined and compared with deaths among a control group who did not have coccidioidomycosis. During the 18-year period, 3,089 coccidioidomycosis-associated deaths occurred among US residents. The overall age-adjusted mortality rate was 0.59 per 1 million person-years; 55,264 potential life-years were lost. Those at highest risk for death were men, persons >65 years, Hispanics, Native Americans, and residents of California or Arizona. Common concurrent conditions were HIV and other immunosuppressive conditions. The number of deaths from coccidioidomycosis might be greater than currently appreciated.Pulmonary infection can result from inhalation of 1 spore; however, high numbers of spores are more likely to result in symptomatic disease. With rare exception, animal-to-person or person-to-person transmission does not occur. The incubation period is 1–4 weeks. Most patients are asymptomatic, but others might have an acute or chronic disease that initially resembles a protracted respiratory or pneumonia-like febrile illness primarily involving the bronchopulmonary system. Dissemination to multiple organ systems can occur. Illness is typically characterized by >1 of the following: influenza-like signs and symptoms; pulmonary lesion diagnosed by chest radiograph; erythema nodosum or erythema multiforme rash; meningitis; or involvement of bones, joints, skin, viscera, and lymph nodes (14,15). Extrapulmonary manifestations occur in 0.6% of the general population, most commonly secondary to hematogenous spread; meningitis carries an especially grave prognosis (16). The risk for disseminated disease is significantly higher among men (17), those with compromised or suppressed immune systems (e.g., persons with HIV), those receiving corticosteroids, and pregnant women. Risk for disseminated disease also seems to be higher for African Americans and Filipino Americans (18).
Despite the potential for coccidioidomycosis to be severe and fatal, studies of deaths associated with coccidioidomycosis in the United States are limited (19,20). To determine possible risk factors for coccidioidomycosis-associated death, we used US multiple-cause-of-death data to assess demographics, secular trends, geographic distribution, and concurrent conditions.
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