title: Coccidioidomycosis in non-endemic areas: a case series.
abstract: Coccidioidomycosis is a systemic infection caused by the soil fungus Coccidioides immitis, which is endemic to the south-western United States. Manifestations range from flu-like illness to pneumonia and septic shock. Diagnosis may be delayed or missed in non-endemic areas because of the low index of suspicion. We describe a series of 23 patients with coccidioidomycosis at one institution in a non-endemic area. Diagnosis was often delayed. In two patients, the route of exposure could not be determined, but 20 patients had a history of residence or travel to endemic areas, and the remaining patient had an occupational history of exposure to fomites from an endemic region. Five patients were immunosuppressed. Most patients responded well to medical therapy, surgery, or both. Although coccidioidomycosis is rare in non-endemic areas, physicians must keep it in mind when evaluating patients who have traveled to endemic areas or who are immunosuppressed.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Yale University School of Medicine, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Desai
authors.forename: O A
authors.initials: OA
authors.lastname: Minai
authors.forename: S M
authors.initials: SM
authors.lastname: Gordon
authors.forename: B
authors.initials: B
authors.lastname: O'Neil
authors.forename: H P
authors.initials: HP
authors.lastname: Wiedemann
authors.forename: A C
authors.initials: AC
authors.lastname: Arroliga
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019353:Endemic Diseases; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012189:Retrospective Studies; D012307:Risk Factors; D012698:Serologic Tests; D014195:Travel
chemical_list: D000935:Antifungal Agents