Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006–2015
Adrienne Carey, Morgan E. Gorris, Tom Chiller, Brendan R. Jackson, Wei Beadles, Brandon Webb
Abstract
C occidioidomycosis, also known as Valley fever, is caused by Coccidioides immitis and C. posadasii, endemic, dimorphic environmental fungi found in the soil of the southwestern United States, Mexico, and Central and South America (1). Clinical infection ranges from asymptomatic to diverse manifestations including pneumonia, soft tissue and osteoarticular infection, meningitis, and disseminated disease (2). On the basis of fi ndings from the seminal 1957 seropositivity survey (3) that established the com-monly accepted geographic distribution of Coccidioides in the United States, 6 states were classifi ed as coccidioidomycosis-endemic (Arizona, California, Nevada, New Mexico, Texas, and Utah); California and Arizona had the highest seroprevalence (4). On the basis of that study, 3 counties in southwestern Utah were considered coccidioidomycosis-endemic: Iron, Kane, and Washington (3). With the exception of reports from a widely publicized 2001 outbreak of coccidioidomycosis at an archeological dig in Uintah County in the US Park Service's Dinosaur National Monument (5-7), there are few published data on this disease in Utah. However, recent data suggest that southwestern Utah might represent an area of increased disease burden (8). Here we report a description of the epidemiology of coccidioidomycosis in Utah and explore environmental and climatic factors contributing to regional variations in statewide incidence using data from cases reported to the Utah Department of Health (UDOH) during 2009-2015. We also describe clinical characteristics and outcomes using patient-level data from the Intermountain Healthcare System during 2006-2015.