Infectious Disease Epidemiology
Coccidioidomycosis: Technical Information
Coccidioidomycosis in ArizonaCoccidioidomycosis is thought to be greatly under-diagnosed and under-reported. A high index of suspicion is needed in areas with high cocci prevalence and appropriate tests should be ordered when dealing with persons with compatible symptoms.
ADHS strongly recommends that laboratory testing for coccidioidomycosis (serologic or mycologic) be done routinely in Arizona patients with community acquired pneumonia.
Reporting Requirements
Characteristics
- Infectious Agent: Coccidioides immitis (a dimorphic fungus)
- Mode of Transmission: Inhalation of airborne spores from the soil. Valley Fever is not contagious person to person or animal to person.
- Incubation Period: Typically 10-16 days, but can range from 7 to 28 days.
- Clinical Features
- Asymptomatic Coccidioidomycosis:
- Most cases (60%) have no symptoms or only very mild flu-like symptoms.
- Pulmonary Coccidioidomycosis:
- Primary pulmonary presentation is quite varied, occurring in 35% of the cases. It is divided into acute and chronic phases.
- Acute - 95% of symptomatic cases will have acute symptoms and most will resolve without complications.
- Flu-like symptoms (fever, cough, body aches)
- Pulmonary symptoms (cough, chest pain, shortness of breath, pleurisy, fatigue, and fever)
- Pneumonia
- Skin manifestations (from papular nonpruitic rash to erythema nodosum or erytheum migrans)
- Migratory arthralgias and fever ("desert rheumatism")
- Acute respiratory distress (ARDS)
- Chronic - 5% of the cases will develop chronic diseases that can be sequelae to the above acute presentation and other presentations are quite varied, from developing pulmonary nodules to pulmonary cavities.
- Severe pulmonary disease may develop in HIV-infected persons.
- Disseminated Coccidioidomycosis:
- Develops in 5% of the cases and is quite varied depending on the organs involved. The most common effects are:
- Skin - abscesses and ulcers
- Joints and bones - synovitis, effusion, lytic lesion (especially of the axial skeleton)
- Meninges - meningitis (presenting with fever, headache, neck pain, and photophobia)
Arizona Administrative Code: R9-6-314
Outbreak control measures: A local health agency shall conduct an epidemiologic investigation of each reported outbreak of coccidioidomycosis.
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