Coccidioidomycosis in Arizona: Are the elderly at increased risk?

J. Leake, D. Mosley, R. England, J. Graham, B. Plikaytis, Neil M. Ampel, B. Perkins, R. Hajjeh

Research output: Contribution to journalArticle

Abstract

The incidence of Coccidioidomycosis (CM), an airborne fungal infection endemic to the southwestern U.S., more than doubled in Arizona among persons > 65 years between 1990 and 1995 (14.9 to 35.0/100,000 pop.). The role of recent migration to Arizona in predisposing elderly residents to CM was unclear. We conducted a case-control study of risk factors for CM in persons > 60 years in Arizona. A case was defined as laboratory-confirmed clinical diagnosis of incident CM. We systematically selected cases occurring from January 1, 1996, to February 15, 1997, from state surveillance. We enrolled two control groups, the first via random-digit dialing (group 1), and the second using 1996 lists from three major Arizona laboratories of subjects with negative serologic results for CM (group 2). A total of 89 case-patients (65% male, 92% while, median age=73 years), and 91 group 1, and 58 group 2 controls were enrolled. The median duration of Arizona residence among case vs. control groups 1 and 2 was 6.5 vs. 19.5 and 11.0 years, respectively. Compared with control groups, case-patients spent significantly less time in Arizona (p<0.005 for group 1; p<0.05 for group 2). Controlling for time spent in Arizona, case-patients were also more likely than group I controls to have histories of congestive heart failure (OR 8.3, 95% CI 1.3-54.7), cancer (OR 3.2, 95% CI 1.1-9.0), smoking (OR 3.7,95% CI 1.4-9.6) or taking corticosteroids (OR 6.8, 95% CI 1.2-39.7). Most patients (89%) presented with upper respiratory symptoms. Elderly migrants to Arizona had increased risk of developing CM. This risk was not due to selective testing of newcomers to Arizona; risk persisted when case-patients were compared with other persons undergoing serologic testing. Underlying illnesses were independent risk factors for CM. Elderly migrants to Arizona should be made aware of the increased risk of developing CM, and should be considered for vaccination when a safe, effective vaccine becomes available.

Original languageEnglish (US)
Pages (from-to)380
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - 1997
Externally publishedYes

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Coccidioidomycosis
Control Groups
Mycoses
Case-Control Studies
Adrenal Cortex Hormones
Vaccination
Vaccines
Heart Failure
Smoking

ASJC Scopus subject areas

  • Immunology

Cite this

Leake, J., Mosley, D., England, R., Graham, J., Plikaytis, B., Ampel, N. M., ... Hajjeh, R. (1997). Coccidioidomycosis in Arizona: Are the elderly at increased risk? Clinical Infectious Diseases, 25(2), 380.

Coccidioidomycosis in Arizona : Are the elderly at increased risk? / Leake, J.; Mosley, D.; England, R.; Graham, J.; Plikaytis, B.; Ampel, Neil M.; Perkins, B.; Hajjeh, R.

In: Clinical Infectious Diseases, Vol. 25, No. 2, 1997, p. 380.

Research output: Contribution to journalArticle

Leake, J, Mosley, D, England, R, Graham, J, Plikaytis, B, Ampel, NM, Perkins, B & Hajjeh, R 1997, 'Coccidioidomycosis in Arizona: Are the elderly at increased risk?', Clinical Infectious Diseases, vol. 25, no. 2, pp. 380.
Leake J, Mosley D, England R, Graham J, Plikaytis B, Ampel NM et al. Coccidioidomycosis in Arizona: Are the elderly at increased risk? Clinical Infectious Diseases. 1997;25(2):380.
Leake, J. ; Mosley, D. ; England, R. ; Graham, J. ; Plikaytis, B. ; Ampel, Neil M. ; Perkins, B. ; Hajjeh, R. / Coccidioidomycosis in Arizona : Are the elderly at increased risk?. In: Clinical Infectious Diseases. 1997 ; Vol. 25, No. 2. pp. 380.
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abstract = "The incidence of Coccidioidomycosis (CM), an airborne fungal infection endemic to the southwestern U.S., more than doubled in Arizona among persons > 65 years between 1990 and 1995 (14.9 to 35.0/100,000 pop.). The role of recent migration to Arizona in predisposing elderly residents to CM was unclear. We conducted a case-control study of risk factors for CM in persons > 60 years in Arizona. A case was defined as laboratory-confirmed clinical diagnosis of incident CM. We systematically selected cases occurring from January 1, 1996, to February 15, 1997, from state surveillance. We enrolled two control groups, the first via random-digit dialing (group 1), and the second using 1996 lists from three major Arizona laboratories of subjects with negative serologic results for CM (group 2). A total of 89 case-patients (65{\%} male, 92{\%} while, median age=73 years), and 91 group 1, and 58 group 2 controls were enrolled. The median duration of Arizona residence among case vs. control groups 1 and 2 was 6.5 vs. 19.5 and 11.0 years, respectively. Compared with control groups, case-patients spent significantly less time in Arizona (p<0.005 for group 1; p<0.05 for group 2). Controlling for time spent in Arizona, case-patients were also more likely than group I controls to have histories of congestive heart failure (OR 8.3, 95{\%} CI 1.3-54.7), cancer (OR 3.2, 95{\%} CI 1.1-9.0), smoking (OR 3.7,95{\%} CI 1.4-9.6) or taking corticosteroids (OR 6.8, 95{\%} CI 1.2-39.7). Most patients (89{\%}) presented with upper respiratory symptoms. Elderly migrants to Arizona had increased risk of developing CM. This risk was not due to selective testing of newcomers to Arizona; risk persisted when case-patients were compared with other persons undergoing serologic testing. Underlying illnesses were independent risk factors for CM. Elderly migrants to Arizona should be made aware of the increased risk of developing CM, and should be considered for vaccination when a safe, effective vaccine becomes available.",
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