Pulmonary and extrapulmonary coccidioidomycosis, active component, U.S. Armed Forces, 1999-2011

Coccidioidomycosis is an infection caused by inhalation of Coccidioides species of fungi, which grow in the soil of the southwestern United States. Many thousands of military service members are assigned to, or perform training in, the endemic region. During the 13 years 1999 through 2011, 483 active component service members were diagnosed with coccidioidomycosis (rate: 2.69 cases per 100,000 person-years). Twelve percent of all diagnoses specified extrapulmonary infection, indicating dissemination to other organ systems (e.g., skin, skeleton, or central nervous system). Service members of Asian/Pacific Islander race had markedly higher incidence rates of coccidioidomycosis, particularly extrapulmonary disease, compared to members of other racial/ethnic groups. Crude incidence rates of coccidioidomycosis in service members older than 40 and males were higher than the rates of their respective counterparts. Preventive strategies to reduce exposure to this environmental pathogen are discussed.