1. Environmental Fungal Diseases What can we learn together?
Orion McCotter, MPH
Mycotic Diseases Branch
HAQAST
Madison, WI
July 17, 2018

2. Coccidioidomycosis (Valley fever)
Environmental form
Coccidioides spp.
Host-associated form
Coccidioidomycosis
(Valley fever)
Valley fever is caused by two closely related fungi, Coccidioides immitis or posadasii, which are found in the desert soil in the western United States
People become infected by inhaling the infections spores (or arthroconidia) from the environment
Inside the host, the fungus form a specialized parasitic phase that colonizes the lungs and disseminates to other organs.

3. Valley fever impact on Patients
Symptoms last median of 120 days
40% require hospitalization
~$50,000 a visit
1% life-threatening or disseminated disease
75% miss >14 workdays
This diseases has a tremendous negative impact on patients
Many of them require prolong hospitalization
Two thirds miss more than 2 weeks of work,
The median length of symptoms onset is 120 days
So this is a disease with very high personal and economical impact

4. Reported Cases of Coccidioidomycosis in the U.S., 1998-2016
Experts estimate 150,000 cases annually
Preliminary 2017 data: over 15,000 cases for AZ + CA
Some of the variation in reported cases probably reflects true changes in the number of cases and may be related to environmental factors or changes in the at-risk population, but several changes in reporting practices and lab testing practices also occurred during this time.
2008: CSTE case definition changed so that anyone with a single positive lab test result gets counted as a case
2010: cocci becomes lab-reportable in CA
2012: in December, a major commercial lab in AZ switched to a different EIA that is likely more specific than the previous test

5. Where is it? Skin Testing Studies late 1940s early 1950s
Prevalence of sensitivity to coccidioidin, with special reference to specific and nonspecific reactions to coccidioidin and to histoplasmin.
EDWARDS PQ, PALMER CE. Dis Chest Jan;31(1):35-60.

6. Outbreaks

7. Understanding the geographic range

8. Environmental Aspects Precipitation, Drought, Soil Moisture
Complex life cycle in environment
Preceding precipitation, soil moisture for fungus to grow
Period of drought for soil to be disturbed
Comrie AC. Climate Factors Influencing Coccidioidomycosis Seasonality and Outbreaks Environmental Health Perspectives, 113(6):
Tamerius, J.D. and Comrie, A.C., Coccidioidomycosis incidence in Arizona predicted by seasonal precipitation PLoS ONE, 6(6): e21009.
Coopersmith EJ, Bell JE, Benedict K, Shriber J, McCotter O, Cosh MH. Relating coccidioidomycosis (valley fever) incidence to soil moisture conditions GeoHealth, 1(1):

9. What is the role of dust storms in transmission?

10. Environmental sampling techniques have improved

11. Histoplasmosis
Histoplasmosis is another fungal regional disease which. We are working to collect information on these diseases such as histoplasmosis. We have been working in 12 states in which Histoplasmosis is reportable to understand the disease.

13. Known endemic areas cover most of the US Much more to be learned about the environmental aspects

14. Conclusions
We need to build more collaborations to help better define ecological niche and understand areas of geographic risk
Increased work and modeling can help improve understanding of environmental factors
How can we work utilize some of these tools for fungal diseases?

15. Thank You omccotter@cdc.gov