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Coccidioidomycosis - For Providers

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Published on December 30, 2016. Last modified on December 28, 2018

December 28, 2018: Increase in Local Pediatric Coccidioidomycosis

Current Situation:

A larger than usual number of children have been diagnosed with coccidioidomycosis this season. 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. While individuals may become infected and ill at any time of the year, the highest rates of illness normally occur between September and March. This season, ten children have been diagnosed with coccidioidomycosis, compared to three children from 2015 to 2017 combined. No epidemiologic link between pediatric cases has been identified to date. These children reside in different areas of Monterey County. The County Health Officer urges medical providers to include coccidioidomycosis in their differential diagnoses when evaluating patients with progressive respiratory illness or lingering cough.

Recommendations for Health Care 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, Kern County Public Health Laboratory, and 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.
  • 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

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