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.
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