697. Coccidioidomycosis Acquired in Washington State:  Expansion of the Endemic Region?
Session: Oral Abstract Session: What's New in Mycology?
Friday, October 19, 2012: 11:15 AM
Room: SDCC 32 AB
Background: Coccidioidomycosis is caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. The organisms have been found solely in the semiarid to arid climates of the southwestern United States, Mexico, and parts of central and South America. Washington State, located in the Pacific Northwest, conducts passive notifiable conditions surveillance for coccidioidomycosis. Washington residents with coccidioidomycosis typically report travel to a known endemic area. We observed three acute cases in eastern Washington residents without recent travel.

Methods: Case-patients were interviewed to collect exposure activities. Local environmental conditions were evaluated. Medical records and public health surveillance data were reviewed. Clinical specimens were tested by culture and serologic assays.

Results: Two case-patients developed pneumonia and the third suffered a cutaneous knee infection with inguinal lymphangitis and lymphadenopathy following an injury on a dirt track. All three live in a relatively small tri-county area of eastern Washington, where they had extensive exposure to soil either occupationally or through childhood play. The elevation, temperature, and annual rainfall in this area meet the criteria known to be favorable to Coccidioides spp growth. Clinical and laboratory evidence were compatible with recently acquired coccidioidal infections, including seroconversion from IgM to IgG antibodies. Cultures from all patients yielded Coccidioides immitis. Imaging studies and patient history did not reveal any pre-existing pulmonary infections to suggest prior exposure with reactivation.  

Conclusion: We propose that these three case-patients acquired coccidioidomycosis locally based on serologic and epidemiologic evidence and the ecologic plausibility given the local environmental conditions. These cases suggest that Coccidioides immitis may be present in the soil of eastern Washington, significantly further north of previously defined endemic areas. Healthcare providers should be aware of this possibility and consider the diagnosis and appropriate testing in clinically compatible cases even in the absence of travel to previously established endemic areas.

Nicola Marsden-Haug, MPH1, Marcia Goldoft, MD, MPH1, Cindy Ralston, RN2, Ajit Limaye, MD, FIDSA3, Jimmy Chua, MD4, Heather Hill, RN, PHN2, Larry Jecha, MD2, George R. Thompson III, MD5 and Tom Chiller, MD, MPH6, (1)Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, WA, (2)Benton-Franklin Health District, Kennewick, WA, (3)University of Washington, Seattle, WA, (4)Infectious Disease, Kennewick General Hospital, Kennewick, WA, (5)Medical Microbiology and Immunology, University of California-Davis, Davis, CA, (6)Centers for Disease Control and Prevention, Atlanta, GA


N. Marsden-Haug, None

M. Goldoft, None

C. Ralston, None

A. Limaye, None

J. Chua, Vertex: Speaker's Bureau, Speaker honorarium
Genentech: Speaker's Bureau, Speaker honorarium
Forest: Speaker's Bureau, Speaker honorarium
Pfizer: Speaker's Bureau, Speaker honorarium
Merck: Speaker's Bureau, Speaker honorarium

H. Hill, None

L. Jecha, None

G. R. Thompson III, None

T. Chiller, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.