Journal Article

Outcomes among Inmates Treated for Coccidioidomycosis at a Correctional Institution during a Community Outbreak, Kern County, California, 2004

Lauren A. Burwell, Benjamin J. Park, Kathleen A. Wannemuehler, Newton Kendig, James Pelton, Emma Chaput, Babatunde A. Jinadu, Kirt Emery, Gil Chavez and Scott K. Fridkin

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 11, pages e113-e119
Published in print December 2009 | ISSN: 1058-4838
Published online December 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/648119
Outcomes among Inmates Treated for Coccidioidomycosis at a Correctional Institution during a Community Outbreak, Kern County, California, 2004

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Background.Treatment of pulmonary coccidioidomycosis is typically limited to patients with severe disease or those with increased risk of dissemination. In response to an increase of coccidioidomycosis at a correctional institution in an endemic area, physicians initiated an enhanced diagnosis and treatment program.

Methods.Case patients were inmates with laboratory-confirmed coccidioidomycosis during January 1, 2003, through October 31, 2004. We abstracted medical record data, including demographics, IgG complement fixation (CF) titers, treatment, and clinical outcome for initial and follow-up visits. Case patients receiving antifungal treatment were categorized into early (⩽4 weeks from symptom onset) and late treatment groups (>4 weeks after symptom onset). We evaluated clinical outcome, median IgG CF titer, and time to clinical improvement.

Results.Eighty-seven persons were diagnosed with coccidioidomycosis; 79 (91%) records were available. Median age was 36 years (range, 21–71 years), 34 (43%) were black, and all were male. Median time from symptom onset to diagnosis was 3 weeks (range, <1–36 weeks). Most (95%) received antifungal therapy; 32 were in the early treatment and 43 were in the late treatment group. Good clinical outcome was equally likely. In both groups, median peak IgG CF titers were 1:64. Titers in patients with early treatment did not decrease more rapidly. Median time to improvement was similar in early and late treatment groups (7 and 6 months, respectively; P=.6).

Conclusions.Persons incarcerated in endemic areas constitute a susceptible population that should be considered at risk for coccidioidomycosis. Further studies are needed to identify populations that may benefit from early antifungal treatment for pulmonary coccidioidomycosis.

Journal Article.  3901 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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