Outbreak of coccidioidomycosis in Washington State residents returning from Mexico

In July 1996 the Washington State Department of Health (Seattle) was notifi ed of a cluster of a flulike, rash-associated illness in a 126-member churc h group, many of whom were adolescents. The group had recently returned fro m Tecate, Mexico, where members had assisted with construction projects at an orphanage, After 1 member was diagnosed with coccidioidomycosis, we init iated a study to identify further cases. We identified 21 serologically con firmed cases of coccidioidomycosis (minimum attack rate, 17%), Twenty cases (95%) occurred in adolescents, and 13 patients (62%) had rash, Sixteen sym ptomatic patients saw 19 health care providers; 1 health care provider corr ectly diagnosed coccidioidomycosis, Coccidioides immitis was isolated from soil samples from Tecate by use of the intraperitoneal mouse inoculation me thod. Trip organizers were unaware of the potential for C. immitis infectio n. Travelers visiting regions where C, immitis is endemic should be made aw are of the risk of acquiring coccidioidomycosis, and health care providers should be familiar with coccidioidomycosis and its diagnosis.