title: Testing for coccidioidomycosis among patients with community-acquired pneumonia.
abstract: Coccidioidomycosis is a common cause of community-acquired pneumonia (CAP) in disease-endemic areas. Because testing rates influence interpretation of reportable-disease data and quality of CAP patient care, we determined the proportion of CAP patients who were tested for Coccidioides spp., identified testing predictors, and determined the proportion of tested patients who had positive coccidioidomycosis results. Cohort studies to determine the proportion of ambulatory CAP patients who were tested in 2 healthcare systems in metropolitan Phoenix found testing rates of 2% and 13%. A case-control study identified significant predictors of testing to be age >/=18 years, rash, chest pain, and symptoms for >/=14 days. Serologic testing confirmed coccidioidomycosis in 9 (15%) of 60 tested patients, suggesting that the proportion of CAP caused by coccidioidomycosis was substantial. However, because Coccidioides spp. testing among CAP patients was infrequent, reportable-disease data, which rely on positive diagnostic test results, greatly underestimate the true disease prevalence.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Chang
authors.forename: Shoana
authors.initials: S
authors.lastname: Anderson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wannemuehler
authors.forename: David M
authors.initials: DM
authors.lastname: Engelthaler
authors.forename: Laura
authors.initials: L
authors.lastname: Erhart
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Sunenshine
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Burwell
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
mesh_terms: D001130:Arizona / Q000453:epidemiology; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D019353:Endemic Diseases; D006801:Humans; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies