Volume 28, Number 6—June 2022
CME ACTIVITY - Synopsis
Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA
Ferris A. Ramadan
, Katherine D. Ellingson, Robert A. Canales, Edward J. Bedrick, John N. Galgiani, and Fariba M. Donovan
, Katherine D. Ellingson, Robert A. Canales, Edward J. Bedrick, John N. Galgiani, and Fariba M. Donovan
Table 2
Characteristics of inpatients and outpatients by confirmed Coccidioides diagnosis in a cross-sectional study of clinical predictors of coccidioidomycosis, Arizona, USA*
| Characteristics | Outpatient |
Inpatient |
Total, n = 392 | p value |
||||
|---|---|---|---|---|---|---|---|---|
| Positive, n = 35 | Negative, n = 64 | Positive, n = 38 | Negative, n = 255 | Outpatient | Inpatient | |||
| Median age, y (range) |
57 (24–77) |
51 (19–93) |
45 (18–83) |
58 (18–98) |
57 (18–98) |
0.534 |
0.022 |
|
| Sex, no. (%) | 0.289 | 1.000 | ||||||
| F | 20 (58.8) | 29 (46) | 18 (47.4) | 123 (48.4) | 190 (48.8) | |||
| M |
14 (41.2) |
34 (54) |
20 (52.6) |
131 (51.6) |
199 (51.2) |
|||
| Race, no. (%) | 0.574 | 0.018 | ||||||
| African American | 2 (5.9) | 4 (6.6) | 6 (16.7) | 14 (5.6) | 26 (6.8) | |||
| AI/AN | 4 (11.8) | 2 (3.3) | 2 (5.6) | 9 (3.6) | 17 (4.5) | |||
| Asian | 1 (2.9) | 2 (3.3) | 2 (5.6) | 2 (0.8) | 7 (1.8) | |||
| White | 27 (79.4) | 52 (85.2) | 25 (69.4) | 211 (84.7) | 315 (82.9) | |||
| Unknown |
0 |
1 (1.6) |
1 (2.8) |
13 (5.2) |
15 (3.9) |
|||
| Ethnicity, no. (%) | 0.808 | 1.000 | ||||||
| Hispanic | 8 (25.8) | 18 (30) | 10 (27) | 69 (27.6) | 105 (27.8) | |||
| Non-Hispanic |
23 (74.2) |
42 (70) |
27 (73) |
181 (72.4) |
273 (72.2) |
|||
| Median length of endemic residence, y (range) |
10 (0–59) |
20 (0–88) |
19 (0–78) |
22 (0–98) |
20 (0–98) |
0.091 |
0.331 |
|
| Immunocompromised, no. (%)† | 0.344 | 0.076 | ||||||
| Y | 7 (20.6) | 20 (31.2) | 17 (44.7) | 154 (61.1) | 198 (51) | |||
| N |
27 (79.4) |
44 (68.8) |
21 (55.3) |
98 (38.9) |
190 (49) |
|||
| Median length of Illness, d (range) |
14 (0–300) |
14 (0–5,110) |
14 (2–365) |
14 (1–8,760) |
14 (0–8,760) |
0.370 |
0.972 |
|
| Symptoms, no. (%)‡ | ||||||||
| Fatigue | 19 (54.3) | 39 (60.9) | 27 (71.1) | 203 (79.9) | 288 (73.7) | 0.531 | 0.209 | |
| Cough | 22 (62.9) | 44 (68.8) | 26 (68.4) | 164 (64.6) | 256 (65.5) | 0.656 | 0.718 | |
| Fever | 12 (34.3) | 24 (37.5) | 15 (39.5) | 128 (50.4) | 179 (45.8) | 0.829 | 0.227 | |
| Chest pain | 13 (37.1) | 26 (40.6) | 14 (36.8) | 82 (32.3) | 135 (34.5) | 0.831 | 0.583 | |
| Shortness of breath | 13 (37.1) | 42 (65.6) | 25 (65.8) | 172 (67.7) | 256 (65.5) | 0.011 | 0.853 | |
| Headache | 9 (25.7) | 22 (34.4) | 13 (34.2) | 116 (45.7) | 160 (40.9) | 0.497 | 0.221 | |
| Night sweats | 15 (42.9) | 21 (32.8) | 13 (34.2) | 104 (40.9) | 153 (39.1) | 0.384 | 0.481 | |
| Muscle aches | 13 (37.1) | 28 (43.8) | 10 (26.3) | 122 (47.8) | 163 (41.7) | 0.670 | 0.014 | |
| Joint pain | 13 (37.1) | 14 (21.9) | 7 (18.4) | 82 (32.1) | 126 (32.2) | 0.156 | 0.051 | |
| Rash | 16 (45.7) | 3 (4.7) | 11 (28.9) | 38 (15) | 68 (17.3) | <0.001 | 0.037 | |
| Other |
11 (31.4) |
27 (42.2) |
11 (28.9) |
74 (29.1) |
123 (31.5) |
0.388 |
1.000 |
|
| Laboratory tests, median (range) | ||||||||
| Procalcitonin, ng/mL | 0.05 (0.012–0.27) | 0.10 (0.05–11.59) | 0.11 (0.05–92.34) | 0.165 (0.02–198.5) | 0.11 (0.02–198.5) | <0.001 | 0.617 | |
| C-reactive protein, mg/L | 7.40 (0.7–260) | 17.5 (0.6–266.3) | 46.0 (1.4–170.2) | 68.0 (0.6–557) | 49.00 (0.6–557) | 0.090 | 0.066 | |
| ESR, mm/h | 15.0 (5–76) | 26.0 (1–145) | 45.0 (6.0–122.0) | 46.0 (4–145) | 41.0 (1–145) | 0.222 | 0.427 | |
| Leukocytes, × 103 cells/mm3 | 9.8 (4.6–14) | 8.9 (3.7–26.5) | 9.0 (0.3–24.4) | 10.0 (0.1–45.4) | 9.90 (0.1–45.4) | 0.560 | 0.481 | |
| Hemoglobin, g/dL | 13.8 (12.4–15.9) | 13.3 (6.9–19.7) | 12.0 (7.2–17.4) | 12.0 (4.8–18) | 12.6 (4.8–19.7) | 0.163 | 0.438 | |
| Platelet count, × 103/mm3 | 312.0 (226–457) | 238.0 (94–446) | 260 (10–520) | 239.0 (5–940) | 248.0 (5–940) | <0.001 | 0.676 | |
| Eosinophil count, × 103/µL | 0.39 (0–1.4) | 0.1 (0–0.8) | 0.2 (0.0–3.0) | 0.07 (0.0–4.55) | 0.1 (0–4.55) | <0.001 | 0.015 | |
| Albumin, g/dL | 4.05 (2.5–5) | 3.9 (1.9–5) | 3.0 (1.4–5.0) | 3.1 (0.6–6.4) | 3.5 (0.6–6.4) | 0.483 | 0.333 | |
| Total protein, g/dL | 7.3 (6.2–8.7) | 7.3 (5.9–9.3) | 7.35 (5.4–9.3) | 6.95 (2.5–12.0) | 7.05 (2.5–12) | 0.747 | 0.044 | |
*Inpatient participants were recruited from among hospitalized patients; outpatients were recruited from patients in emergency departments and affiliated clinics. Bold text indicates statistical significance. AI/AN, American Indian/Alaskan Native; ESR, erythrocyte sedimentation rate. †Immunocompromised status was identified as a participant with a weakened immune system at the time of coccidioidomycosis diagnosis, which included participants with type 2 diabetes, HIV/AIDS, lupus, rheumatoid arthritis, or leukemia, and organ transplant recipients and those receiving chemotherapy agents, corticosteroids, and biologic response modifiers. ‡Symptom counts represent the total number of patients reporting the condition.
Page created: March 21, 2022
Page updated: May 20, 2022
Page reviewed: May 20, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.