title: Outcomes among inmates treated for coccidioidomycosis at a correctional institution during a community outbreak, Kern County, California, 2004.
abstract: 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.
authors.affiliation: 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.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Burwell
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Newton
authors.initials: N
authors.lastname: Kendig
authors.forename: James
authors.initials: J
authors.lastname: Pelton
authors.forename: Emma
authors.initials: E
authors.lastname: Chaput
authors.forename: Babatunde A
authors.initials: BA
authors.lastname: Jinadu
authors.forename: Kirt
authors.initials: K
authors.lastname: Emery
authors.forename: Gil
authors.initials: G
authors.lastname: Chavez
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole