Coccidioidomycosis Exposure Assessed by Skin Testing and Environmental Factors in Baja California, Mexico

Baja California is the second-highest state in Mexico for hospital discharges attributed to coccidioidomycosis (CM), yet epidemiological information on exposure patterns in affected communities remains limited. To estimate exposure to Coccidioides and assess its association with environmental factors, we conducted intradermal coccidioidin skin testing among 416 residents across nine regions of Baja California. We analyzed 24 environmental variables, including bioclimatic, topographic, and land use indicators. Overall, 31.9% of participants tested positive. Higher odds of exposure were observed in Valle de las Palmas and La Morita. Exploratory comparisons of environmental variables showed that, in unadjusted analyses, annual precipitation, precipitation during the wettest month, and elevation differed between high- and low-positivity localities. However, after applying the Benjamini-Hochberg false discovery rate correction, none of the evaluated continuous environmental variables remained statistically significant. These findings should therefore be interpreted as exploratory and hypothesis-generating rather than as evidence of an independently defined environmental profile. Overall, the results indicate heterogeneous exposure to Coccidioides across Baja California and suggest exploratory spatial variability in exposure across sampled localities. Because participants were recruited through nonprobability community-based sampling, these findings should be interpreted as exploratory rather than population-representative estimates.