REVIEWCoccidioidomycosis in African Americans
Section snippets
MYCOLOGY AND IMMUNOLOGY
Coccidioides is a dimorphic fungus that thrives in the soil of portions of the southwestern United States (Figure 1) and northern Mexico.3, 6 Two recognized species cause indistinguishable infection in humans: Coccidioides immitis and Coccidioides posadasii.1, 3 Coccidioides species grow as branching septate hyphae when the soil is moist. As the soil dries, thick-walled arthroconidia form6; when the soil and hyphae are disrupted, the disarticulated arthroconidia (spores) may become aerosolized.
INCIDENCE AND PREVALENCE
Recent population growth in the southwestern United States, where Coccidioides is endemic, has been rapid and racially diverse. For example, from 2000 to 2008, the population in Arizona increased 26% to more than 6.5 million persons.11, 12 During that same period, the number of African American residents in Arizona increased by 73%.12 The Southwest also serves as a winter vacation destination for an increasing number of travelers and part-time residents, who may return home after having
COCCIDIOIDOMYCOSIS IN PERSONS OF AFRICAN DESCENT
With the same level of exposure, persons of any particular race are not more likely or less likely to inhale airborne spores than persons of another race. Therefore, there is no known difference in the racial susceptibility to primary coccidioidomycosis.20 Of note, reported incidence data cite only identified cases, usually on the basis of symptoms, and do not reflect all primary coccidioidal infections, 60% of which are asymptomatic. Skin test reactivity to spherulin or coccidioidin more
LIMITATIONS OF LITERATURE
Most of the aforementioned studies are problematic to various degrees; their strengths and weaknesses have been summarized (eTable). Additionally, most of the studies are retrospective, which is a particular problem for studying coccidioidomycosis because asymptomatic or mild to moderate forms of the infection may be unrecognized, leaving only a minority of the more severe cases identified and treated by medical practitioners (and subsequently reported to public health officials). Many studies
MANAGEMENT
Treatment of coccidioidomycosis varies according to the clinical manifestations and anatomical sites of the infection. Specific antifungal drugs and treatment plans have recently been outlined in guidelines of the Infectious Diseases Society of America.54 The first step in management is to define the extent of a patient's disease.55
Optimal treatment of patients with self-limited pulmonary infection is an unsettled issue. Many experts do not recommend specific antifungal therapy in this
CONCLUSION
Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Numerous retrospective studies have suggested that African Americans have an increased risk of severe or disseminated coccidioidal infections, but many of these studies are small and subject to potential bias. Prospective, controlled epidemiological studies are required to give a clearer picture of the true risk of complicated coccidioidomycosis among racial groups. Further study into the nature of inherent
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Cited by (54)
Imaging of Endemic and Opportunistic Fungal Pulmonary Disease
2022, Seminars in RoentgenologyCitation Excerpt :In contrast to histoplasmosis, coccidioidomycosis is more symptomatic, with up to 40% of persons developing symptoms.9,19 Unique to coccidioidomycosis is a racial predication for disseminated disease, which is higher among those of Filipino, African-American, and Pacific Islander ethnicity.20-24 Coccidioidomycosis, both its clinical presentation and imaging findings, can be categorized into acute, disseminated or chronic forms.25,26
Coccidioidomycosis: The valley fever
2021, Encyclopedia of MycologyHow Environmental Fungi Cause a Range of Clinical Outcomes in Susceptible Hosts
2019, Journal of Molecular BiologyCitation Excerpt :Underlying genetic or hormonal factors appear to be more significant susceptibility markers for coccidioidal meningitis. Diabetes [180], pregnancy [181,182], and certain ethnicities (African and Filipino descent) [183,184] all correlate with increased risk for CNS infection [137,179]. Extrapulmonary dissemination occurs in ~ 30% of transplant recipients with coccidioidomycosis, making it a far more frequent occurrence than in the general population [169–171].
Coccidioides immitis and Coccidioides posadasii (Coccidioidomycosis)
2018, Principles and Practice of Pediatric Infectious DiseasesRace and ethnicity: Risk factors for fungal infections?
2023, PLoS Pathogens