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, Scott K. Fridkin

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalClinical Infectious Diseases
Volume49
Issue number11
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Coccidioidomycosis
Disease Outbreaks
Therapeutics
Immunoglobulin G
Lung
Population
Medical Records
Demography

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Outcomes among inmates treated for coccidioidomycosis at a correctional institution during a community outbreak, kern county, California, 2004. / Burwell, Lauren A.; Park, Benjamin J.; Wannemuehler, Kathleen A.; Kendig, Newton; Pelton, James; Chaput, Emma; Jinadu, Babatunde A.; Emery, Kirt; Chavez, Gil; Fridkin, Scott K.

In: Clinical Infectious Diseases, Vol. 49, No. 11, 12.2009.

Research output: Contribution to journalArticle

Burwell, Lauren A. ; Park, Benjamin J. ; Wannemuehler, Kathleen A. ; Kendig, Newton ; Pelton, James ; Chaput, Emma ; Jinadu, Babatunde A. ; Emery, Kirt ; Chavez, Gil ; Fridkin, Scott K. / Outcomes among inmates treated for coccidioidomycosis at a correctional institution during a community outbreak, kern county, California, 2004. In: Clinical Infectious Diseases. 2009 ; Vol. 49, No. 11.
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abstract = "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.",
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AU - Burwell, Lauren A.

AU - Park, Benjamin J.

AU - Wannemuehler, Kathleen A.

AU - Kendig, Newton

AU - Pelton, James

AU - Chaput, Emma

AU - Jinadu, Babatunde A.

AU - Emery, Kirt

AU - Chavez, Gil

AU - Fridkin, Scott K.

PY - 2009/12

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N2 - 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.

AB - 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.

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DO - 10.1086/648119

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