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- Title
Outcomes among Inmates Treated for Coccidioidomycosis at a Correctional Institution during a Community Outbreak, Kern County, California, 2004.
- Authors
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.
- 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.
- Subjects
KERN County (Calif.); CALIFORNIA; COCCIDIOIDOMYCOSIS; INSTITUTIONALIZED persons; CORRECTIONAL institutions; PHYSICIANS; ANTIFUNGAL agents; IMMUNOGLOBULIN G; SYMPTOMS; DISEASES; THERAPEUTICS
- Publication
Clinical Infectious Diseases, 2009, Vol 49, Issue 11, pe113
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1086/648119