Outcomes among inmates treated for coccidioidomycosis at a correctional institution during a community outbreak, Kern County, California, 2004.
BACKGROUND
Treatment of pulmonary coccidioidomycosis is typically limited to patients with severe disease or those with increased risk of dissemination. In response to an increase of coccidioidomycosis at a correctional institution in an endemic area, physicians initiated an enhanced diagnosis and treatment program.


METHODS
Case patients were inmates with laboratory-confirmed coccidioidomycosis during January 1, 2003, through October 31, 2004. We abstracted medical record data, including demographics, IgG complement fixation (CF) titers, treatment, and clinical outcome for initial and follow-up visits. Case patients receiving antifungal treatment were categorized into early (<or=4 weeks from symptom onset) and late treatment groups (>4 weeks after symptom onset). We evaluated clinical outcome, median IgG CF titer, and time to clinical improvement.


RESULTS
Eighty-seven persons were diagnosed with coccidioidomycosis; 79 (91%) records were available. Median age was 36 years (range, 21-71 years), 34 (43%) were black, and all were male. Median time from symptom onset to diagnosis was 3 weeks (range, <1-36 weeks). Most (95%) received antifungal therapy; 32 were in the early treatment and 43 were in the late treatment group. Good clinical outcome was equally likely. In both groups, median peak IgG CF titers were 1:64. Titers in patients with early treatment did not decrease more rapidly. Median time to improvement was similar in early and late treatment groups (7 and 6 months, respectively; P = .6).


CONCLUSIONS
Persons incarcerated in endemic areas constitute a susceptible population that should be considered at risk for coccidioidomycosis. Further studies are needed to identify populations that may benefit from early antifungal treatment for pulmonary coccidioidomycosis.
Burwell
Lauren A
LA
Epidemic Intelligence Service, Office of Workforce and Career Development, and Mycotic Diseases Branch, Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Park
Benjamin J
BJ
Wannemuehler
Kathleen A
KA
Kendig
Newton
N
Pelton
James
J
Chaput
Emma
E
Jinadu
Babatunde A
BA
Emery
Kirt
K
Chavez
Gil
G
Fridkin
Scott K
SK
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002140:California; D003047:Coccidioidomycosis / Q000188:drug therapy* / Q000453:epidemiology*; D004196:Disease Outbreaks; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents; D015725:Fluconazole