Travel associated human coccidioidomycosis in Germany 2011-2023

This study reviews proven coccidioidomycosis cases in Germany associated with travel between 2011 and 2023 to endemic regions. We characterize clinical presentation, diagnostic practices, antifungal susceptibility, and molecular epidemiology. Fifteen human cases were confirmed by culture (12 cases) and histology (3 cases), with infections caused by Coccidioides posadasii (10 cases) and C. immitis (2 cases). Patients ranged from 23 to 82 years old, mostly without significant comorbidities. Clinical manifestations included pulmonary (6 cases), CNS (2 cases), and disseminated disease (3 cases). Serologic testing showed high sensitivity for lateral flow assays (100 %) compared to immunodiffusion (82 %). In vitro susceptibility testing indicated strong activity of amphotericin B and azole antifungals. Whole-genome sequencing revealed that most infections originated from Arizona, clustering with known clades. The findings highlight that coccidioidomycosis is rarely diagnosed in Germany but does occur in previously healthy individuals with travel to endemic regions. Importantly, antibody detection via lateral flow assay is a useful screening tool in non-endemic settings.