| Clinical
Features |
Symptomatic infection (40% of cases)
usually presents as flu-like illness with fever, cough, headaches,
rash, and myalgias. Some patients fail to recover and develop
chronic pulmonary infection or widespread disseminated infection
(affecting meninges, soft tissues, joints, and bone). Severe
pulmonary disease may develop in HIV-infected persons. |
| Etiologic
Agent |
Coccidioides immitis. |
| Reservoir |
Soil in semiarid areas (primarily
in the Lower Sonoran life zone). Endemic in the south-western
United States, parts of Mexico and South America. |
| Incidence |
Incidence was 15 cases per 100,000
population in Arizona in 1995. Of persons living in areas
with endemic disease, 10-50% are skin-test positive. |
| Sequelae |
Meningitis may lead to permanent
neurologic damage. Mortality is high in HIV-infected persons
with diffuse lung disease. |
| Transmission |
Inhalation of airborne arthroconidia
after disturbance of contaminated soil by humans or natural
disasters (e.g., dust storms and earthquakes). |
| Risk
Groups |
Persons in areas with endemic disease
who have occupations exposing them to dust (e.g., construction
or agricultural workers, and archeologists). High risk groups
are African-Americans and Asians, pregnant women during the
third trimester, and immunocompromised persons. |
| Surveillance |
National surveillance through NETSS
started in 1995. Reportable in states with endemic disease:
California, New Mexico, Arizona. |
| Challenges |
Developing an effective vaccine
(vaccination offers the best prevention measure because infection
provides life-long immunity). Identifying factors associated
with increased risk for dissemination in select racial groups
to target prevention efforts. |
|
December 2003
|
