Coccidioidomycosis in India: Report of a third imported case

We describe the third fatal case of imported coccidioidomycosis in India in a 31-year-old mechanical engineer originally from Andhra Pradesh, India, who lived in Gwinner, North Dakota. He had traveled to Arizona in summer of 2006, where he drove tractors in a dusty environment at a tractor production facility near Phoenix, Arizona. He was human immunodeficiency virus (HIV) positive. Initially, he was treated in Fargo, North Dakota, in 2006, with liposomal amphotericin B followed by oral fluconazole. Antiretroviral treatment for HIV infection was started. He moved back to India and was admitted to the intensive care unit of St. John's Medical College and Hospital, Bangalore, India. His blood cultures yielded Coccidioides sp. The identity of the isolate was confirmed using the Gen Probe Accuprobe test at the Centers for Disease Control and Prevention, Atlanta, Georgia. In spite of initiation of treatment with antifungal agents (amphotericin B and fluconazole), his condition deteriorated and he expired three days following his admission to the hospital.