Ne. Rosenstein et al., Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996, CLIN INF D, 32(5), 2001, pp. 708-714
Surveillance for coccidioidomycosis (CM) and a case-control study for risk
factors among adults were conducted in Kern County, California. From Januar
y 1995 through December 1996, 905 cases of CM were identified, for an annua
l incidence of 86 cases per 100,000 population. A total of 380 adults were
enrolled in the case-control study: 77 had severe pulmonary disease, 33 had
disseminated disease, and 270 control patients had mild disease. Independe
nt risk factors for severe pulmonary disease included diabetes, recent hist
ory of cigarette smoking, income of <$ 15,000 per year, and older age. Oral
antifungal therapy before hospitalization was associated with a reduced ri
sk of CM pneumonia. Risk factors for disseminated disease were black race,
income of <$ 15,000 per year, and pregnancy. Early treatment of CM with ora
l antifungal agents may prevent severe pulmonary disease in groups consider
ed to be at high risk, such as elderly individuals, persons with diabetes,
and smokers. Persons at risk for severe CM may benefit from vaccination onc
e an effective CM vaccine is available.