Coccidioidomycosis at a university health service

At a single university health service within an endemic area, 172 cases of coccidioidomycosis were retrospectively identified by fungal cultures, serologic studies, or intercurrent skin test conversions. The average annual incidence of symptomatic infection was 0.43% for susceptible students. Peak case rates occurred in November and June (11 cases/10,000 clinic visits) and were 1.5 to 6 times greater than in other months. Although mononucleosis was diagnosed approximately twice as frequently as coccidioidomycosis, coccidioidal infections required 74% more visits per patient and over 3 times longer clinical supervision than did mononucleosis. Although only 2 patients disseminated, diagnosis and management of patients with coccidioidomycosis constituted more than 2% of our clinic's visits, for an estimated annual cost of more than $34,000. Because our patient population is young and otherwise healthy, our estimates of the impact of primary coccidioidal infection may underestimate that on civilian public health as a whole.