186394 Testing for Coccidioidomycosis Among Community-Acquired Pneumonia Patients in Emergency Departments

Sunday, October 26, 2008

Orion McCotter, MPH , Zuckerman College of Public Health, University of Arizona, Tucson, AZ
Roque Miramontes, PA-C, MPH , Mycotic Disease Branch, Center for Disease Control and Prevention, Atlanta, GA
Rebecca Sunenshine, MD , Department of Epidemiology, Arizona Department of Health Services, Phoenix, AZ
Melanie De Boer, PhD , Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ
Laura Erhart, MPH , Department of Epidemiology, Arizona Department of Health Services, Phoenix, AZ
Mark Wright, MD , Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ
Shoana Anderson, MPH , Department of Epidemiology, Arizona Department of Health Services, Phoenix, AZ
Robin Harris, PhD , Department of Epidemiology and Biostatistics, University of Arizona: College of Public Health & Arizona Cancer Center, Tucson, AZ
Tom Chiller, MD, MPH , Mycotic Disease Branch, Center for Disease Control and Prevention, Atlanta, GA
Ken Komatsu, MPH , Department of Epidemiology, Arizona Department of Health Services, Phoenix, AZ
Ben Park, MD , Mycotic Disease Branch, Center for Disease Control and Prevention, Atlanta, GA
Background: Coccidioidomycosis, a reportable fungal disease endemic to the Southwestern US that causes community acquired pneumonia (CAP), is an increasingly important public health problem; reports to the Arizona Department of Health Services (ADHS) have increased almost 10-fold since 1995. Based on data indicating that 30% of CAP patients in the Tucson area had Coccidioidomycosis, ADHS recommended routine Valley Fever testing for CAP patients beginning May 2006. Objective: To measure the frequency of coccidioidomycosis testing among CAP patients and to determine the proportion with coccidioidomycosis. Methods: We performed a retrospective chart review of pneumonia patients presenting to two major Tucson emergency departments since January 2007. CAP was defined as an outpatient with fever, symptoms/signs, and radiographic evidence of pneumonia. Demographic, clinical, and diagnostic data were collected and patients with and without Valley Fever testing were compared by using univariate chi-squared analysis. Results: Of 178 pneumonia patients reviewed thus far, 96 (53.9%) met CAP inclusion criteria. Of those, 17 (17.7%) had coccidioidomycosis testing at the initial visit, and 2 (2.1%) were tested at subsequent visits. One (5.9%) of the 17 initial tests was positive for coccidioidomycosis. No significant differences in demographics or clinical signs among patients who in this cohort were observed. Conclusions: These preliminary results indicate the majority of CAP patients in Tucson emergency departments are not tested for coccidioidomycosis, despite recommendations by public health authorities. Additional physician education is needed to increase testing, which will lead to more accurate CAP diagnoses and ultimately, improved patient outcomes.

Learning Objectives:
Recognize the importance of testing CAP patients for Coccidioidomycosis in endemic regions. Describe the frequency with which emergency department physicians test community-acquired pneumonia patients are tested for Coccidioidomycosis. Evaluate the burden of cocci among this cohort of patients presenting with community acquired pneumonia in an endemic region.

Keywords: Epidemiology, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am completing this study as the final capstone internship project of my MPH.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.