Session: Poster Session: Clinical Mycology II
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Coccidioidomycosis (CM) is a reportable fungal disease endemic to the Southwest US that can cause community acquired pneumonia (CAP). Case surveillance from Arizona Department of Health Services (ADHS) demonstrates an almost 10-fold increase since 1995. Based on data indicating that as much as 29% of CAP may be due to CM, ADHS recommended routine CM testing for CAP patients since May 2006. To better understand testing practices we performed a retrospective chart review of CAP patients presenting to two major Tucson emergency departments (EDs) in 2007. Methods: CAP was defined as an outpatient with fever, lower respiratory tract symptoms/signs, and radiographic evidence of pneumonia. Demographic, clinical, and diagnostic data were collected. We measured the frequency of CM testing among CAP patients and determined the proportion with positive serological results for CM; factors associated with CM testing were calculated using univariate chi-squared analysis. Results: Of 460 patients with a pneumonia diagnosis, 234 (50.9%) met CAP inclusion criteria. Median age of CAP patients was 40 years (range 13-91), and 127 (54.3%) were male. Of 234 CAP patients, 67 (28.6%) had CM tests ordered at the initial visit, 5 (7.5%) tests were canceled so a total of 62 tests were performed. Serological testing for CM was done primarily by immunodiffusion for IgM 61 (98.4%) and IgG 60 (96.8%); 5 (8.3%) were tested by IgG complement fixation. Of the 62 patients with valid results, 5 (8.1%) were positive for CM. CM-tested patients were more likely to report chest pain (p=0.027) than non-tested. Other characteristics were similar between the two groups. Conclusion: Most CAP patients in Tucson EDs are not tested for CM, despite recommendations by public health authorities. Additional physician education is needed to increase testing, which may lead to more accurate CAP diagnoses and improve patient outcomes.
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