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Coccidioidomycosis (Valley fever) missed as a cause of death in the USA

August 09 2017

About 150,000 annual cases of coccidioidomycosis occur each year in the USA (especially in Arizona), and at least as many in Central and South America, of which about ~40% are symptomatic and clinically apparent. In Arizona, there was a 4-fold rise in the incidence of clinical cases between 1997 and 2013, to 90/100,000, yet attributable deaths remained unchanged. Using the capture/recapture approach, Jefferson Jones and colleagues found gross underestimates of coccidioidomycosis deaths in Arizona.

Over the 5 years, 2008-2013, both death certificates and hospital discharge data were analysed for deaths linked to or attributable to coccidioidomycosis. They estimated 1,178 coccidioidomycosis-attributable deaths during 2008–2013 in Arizona, compared with the reported number of 164 attributable deaths and 497 deaths including coccidioidomycosis.

Bone scan (technetium) showing multiple hot spots of coccidioidomycosis in the skull, mandible, neck and shoulder – disseminated disease.

Risks for death were increased for Hispanics (OR 1.3), those under 25 years old (OR 2.5), female, (OR 1.3), HIV-positive  (OR 2.4) and disseminated and/or meningitis (OR 1.7). Being Native American or Black, over 85 years old and having chronic disease were at lower risk.

In the northern states of Mexico, coccidioidomycosis is also common and prior estimates (based on a US rate of 43/100,000) yielded many thousands of cases:

This report comes on the eve of the 7th International Coccidioidomycosis Symposium at Stanford University, California, when experts in the topic converge to discuss better strategies for control of this devastating infection for some individuals.