Session: Poster Session: Clinical Mycology I
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Coccidioidomycosis (valley fever) is a fungal infection endemic to the southwestern United States and northern Mexico. The primary infection is respiratory and is followed in a small percentage of cases by dissemination to bone, joints, skin or meninges. A small prospective study found that up to 29% of patients with community acquired pneumonia (CAP) syndromes in Tucson, Arizona were seropositive for coccidioidomycosis, indicating current or recent infection. This finding led to a recommendation in 2006 by the Arizona Department of Health Services that physicians test patients with CAP for coccidioidomycosis. Another small study, however, suggested that Arizona physicians rarely test such patients. Methods: We used Arizona Health Query, a large database of healthcare information on Arizonans, to examine diagnoses of CAP and valley fever among approximately 3 million persons insured by Arizona Medicaid from 2004 to 2006. Results: In total, there were 125,105 CAP diagnoses and 3,476 valley fever diagnoses. However, only 3.9% of persons with a diagnosis of CAP had coccidioidomycosis testing (serology or fungal culture) within 90 days of the diagnosis. Interestingly, only 35% of persons with a diagnosis of valley fever had coccidiodomycosis testing within 90 days. Among persons with CAP, 821 received a diagnosis of valley fever within 90 days of the CAP diagnosis (CAP-VF cohort). When compared with all persons with CAP, the CAP-VF cohort tended to be younger and had a greater percentage of males. Conclusions: Our data suggest that only a very small percentage of patients with CAP in Arizona are being tested for valley fever, and that physicians may be making the diagnosis of valley fever without supportive laboratory testing. Greater awareness of this disease is needed both inside and outside the endemic area.