ABSTRACT
We used real-time polymerase chain reaction and culture to demonstrate persistent colonization of soils by Coccidioides immitis, an agent of valley fever, in Washington State linked to recent human infections and located outside the endemic range. Whole-genome sequencing confirmed genetic identity between isolates from soil and one of the case-patients.
Subject(s)
Coccidioides/isolation & purification , Coccidioidomycosis/epidemiology , Coccidioidomycosis/microbiology , Endemic Diseases , Soil Microbiology , Cluster Analysis , Coccidioides/classification , Coccidioides/genetics , DNA, Fungal/chemistry , DNA, Fungal/genetics , Genome, Fungal , Humans , Microbiological Techniques , Molecular Sequence Data , Real-Time Polymerase Chain Reaction , Sequence Analysis, DNA , Sequence Homology , WashingtonABSTRACT
Coccidioidomycosis ("valley fever") is caused by inhaling spores of the soil-dwelling fungi Coccidioides immitis or Coccidioides posadasii. Most infections are subclinical. When clinical manifestations do occur (typically 1-4 weeks after exposure), they are similar to those associated with influenza or community-acquired pneumonia. Disseminated disease is rare. Residual pulmonary nodules can lead to chronic lung disease. Fluconazole or other triazoles often are used for treatment, but mild cases often resolve without specific therapy. A total of 17,802 cases were reported in the United States in 2012.
Subject(s)
Coccidioides/classification , Coccidioides/isolation & purification , Soil Microbiology , Coccidioidomycosis/epidemiology , Humans , Washington/epidemiologyABSTRACT
Clinical, laboratory, and epidemiologic evidence suggest that 3 individuals with acute coccidioidomycosis were exposed in Washington State, significantly beyond previously identified endemic areas. Given the patients' lack of recent travel, coccidioidomycosis was not suspected, leading to delays in diagnosis and appropriate therapy. Clinicians should be aware of this possibility and consider the diagnosis.
