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February 28, 2018: Coccidioidomycosis Increasing Locally
Health officials urge medical providers to include coccidioidomycosis in their differential diagnoses when evaluating patients with progressive respiratory illness.
Coccidioidomycosis, also known as Valley Fever, results from inhalation of Coccidioides immitis and Coccidioides posadasii spores. Monterey County is a Coccidioides endemic area, particularly the Salinas Valley and South County regions. Since October 2017 an unusually high number of coccidioidomycosis cases among Monterey County residents was reported by local medical providers. Some individuals were severely ill and required extensive medical care. At this time, Public Health Officials recommend medical providers:
- Be aware of symptoms and risk factors for severe disease.
- Following an incubation period of one to four weeks, clinical manifestations occur in 40% of infected individuals and include one or more of the following: influenza-like illness (e.g., fever, chest pain, cough, myalgia, arthralgia, and/or headache); pneumonia or other pulmonary lesion; erythema nodosum or erythema multiforme rash.
- Disseminated infection, which can be fatal, most commonly involves skin and soft tissues, bones, joints, and the central nervous system.
- Once infected, African-Americans, Filipinos, and other Asians are at higher risk of developing more serious or disseminated illness. Women in their third trimester of pregnancy, diabetics, and immunocompromised individuals are also at high risk of serious disease.
- Take a risk history that includes occupation.
- Certain occupational groups including agricultural workers, construction workers, military personnel, and wildland firefighters may be at increased risk for exposure.
- Test for cocci.
- Coccidioidomycosis may be difficult to distinguish from bacterial and other respiratory infections.
- Fungal cultures and/or coccidioidal serologic testing using immunodiffusion and complement fixation should be considered. These are available at most commercial labs and through the University of California Davis’ Coccidioidomycosis Serology Laboratory. Monterey County Public Health Laboratory offers Nucleic Acid Amplification (NAA) testing for cocci (e.g., sputum and bronchial wash specimens).
- Report all confirmed, probable, and suspect cases.
- Complete a Confidential Morbidity Report (CMR) Form and fax it to 831-754-6682 with any available clinical information on the patient (chest x-ray report, chart notes, laboratory results).
- Patient educational brochures are available for download and printing in English,Spanish, and Tagalog.
For more information about testing, diagnosing, and reporting, please contact the Monterey County Health Department’s Communicable Disease Unit at 831-755-4521. For information about submitting patients’ specimens to the Monterey County Public Health Laboratory, call 831-755-4516. Additional information is available on the CDC's website.