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

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.