On December 4, 2001, CDC was notified by the United Kingdom (UK) Public Health Laboratory Service (PHLS) of a UK resident aged 72 years who had culture-confirmed coccidioidomycosis (i.e., Valley fever) diagnosed in early December. During October 8--12, the patient had attended the world championship of model airplane flying in Lost Hills, California, located in Kern County in the Central Valley of California, an area where coccidioidomycosis is highly endemic (Figure 1). The patient had influenza-like symptoms on approximately October 25, 1 week after returning from Lost Hills. CDC, in collaboration with UK PHLS and the California Department of Health Services, is conducting an investigation.
The championship was an international event with competing teams from 30 countries in the Americas, Europe, and the Pacific. Each participating team had up to 11 members. In addition, several spectators may have traveled with each team.
Coccidioidomycosis is caused by inhalation of arthrospores of the dimorphic fungus Coccidioides immitis. Outbreaks typically have occurred following dust-generating events such as archaeologic digs (1). Forty percent of newly infected persons acquire a self-limited influenza-like syndrome with fever, chest pain, cough, malaise, chills, night sweats, arthralgias, and rash. Disseminated disease may develop involving the meninges, bones, joints, skin, and soft tissues. Infants, pregnant women, persons of Filipino and African descent, and immunosuppressed persons (e.g., those on chronic steroids or with acquired immunodeficiency syndrome) are at increased risk for disseminated infection. Treatment with antifungal drugs usually is required only for severe or disseminated disease (2).
Coccidioidomycosis is diagnosed by culture, histopathology, or serology. Serologic criteria for diagnosis include detection of coccidioidal lgM by immunodiffusion, enzyme immunoassay (EIA), latex agglutination, or tube precipitation, or by detection of rising lgG titers by immunodiffusion, EIA, orcomplementfixation.
Coccidioidomycosis should be considered in the differential diagnosis for persons with a clinically compatible illness and with a history of travel to this event. Persons who attended this event and who acquire symptoms should seek appropriate medical care. Clinical evaluation should include a serum specimen for lgG and lgM titers and appropriate cultures if evidence of disseminated disease exists.
Health-care providers or championship participants and spectators from California are encouraged to contact the California Department of Health Services at 619-692-8664 orknm6@cdc.gov to discuss the need for testing. Other participants, spectators, or health-care providers in the United States or abroad may contact CDC's Mycotic Diseases Branch at 404-639-1299 or tnc4@cdc.gov.
Reported by: A Nicoll, B Evans, N Asgari, S Hahne, E Johnson, Public Health Laboratory Svc, United Kingdom. BA Jinadu, R Talbot, Kern County Dept of Health, Bakersfield; SB Werner, D Vugia, California Dept of Health Svcs. Mycotic Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; and EIS officers, CDC.
References
(1.) CDC. Coccidioidomycosis in workers at an archeologic site--Dinosaur National Monument, Utah, June--July 2001. MMWR 200l;50:1005-8.
(2.) Galgiani JN, Ampel NM, Catanzaro A, Johnson RH, Stevens DA, Williams PL. Practice guidelines for the treatment of coccidioidomyccsis. Clin Infect Dis 2000;30:659-61.
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