Pulmonary coccidioidomycosis in China: Case reports and literature review

Coccidioidomycosis is a fungal infection commonly found in the tropical regions of southwestern United States, such as Arizona, the Central Valley of California, parts of New Mexico, and western Texas. The endemic regions also extend into northern Mexico and include focal endemic areas in sections of Central America and Argentina. Coccidioides species have also been reported in central and southern Utah, Nevada, and the central part of Washington State., the pathogenic bacteria commonly colonize the lungs. China, which is outside the traditionally established endemic area, is witnessing a rise in reported cases of pulmonary coccidioidomycosis. Meanwhile, the comorbidities of the disease began to become complicated. We reported two Chinese patients with pulmonary coccidioidomycosis complicated by organizing pneumonia and reviewed 42 cases of Chinese patients in the literature from 1958 to 2024. Out of the 44 patients from 13 different provinces (Including Hong Kong Special Administrative Region and Taiwan), the average age was (43.08 ± 3.03) years. Among them, 34 (76.7 %) were male, while 10 (23.3 %) were female, cough/sputum (81.8 %) are the most common symptoms, the cases are concentrated in coastal areas. 27(61.4 %) were Imported and 17(38.6 %) were domestic primary cases, showing a higher proportion of imported cases compared to domestic primary cases. Misdiagnosis and mistreatment have a significant impact on patients, the combination of new technologies and traditional pathology diagnosis have substantially promoted precise diagnosis for clinician in non-endemic areas. Interestingly, the histopathological findings of the two patients we report showed evident organizing pneumonia and an increased eosinophil count, the application of corticosteroid drugs notably improved the patients' conditions. Overall, at least 84.1 % of patients had a favorable prognosis. Considering the changing epidemiology of pulmonary coccidioidomycosis, Chinese healthcare providers should be cautious about their patients' travel history, particularly among male individuals.