Pulmonary coccidioidomycosis in Kentucky

Coccidioidomycosis is a highly infectious disease caused by the dimorphic fungus, Coccidioides immitis that is endemic to the arid and semiarid regions of the southwestern United States, Mexico, Central America, and South America. The majority of infections from C immitis are asymptomatic; however, approximately 40% of infected individuals present with symptoms ranging from a mild flu-like respiratory infection to acute pneumonia that may lead to chronic progressive pulmonary infection or occasionally disseminated disease. Due to the mobility of the population, increasing numbers of cases are being recognized outside endemic areas. We report five patients with coccidioidomycosis diagnosed at the University of Kentucky Medical Center during the period from 1984 to 1993 in order to illustrate the clinical and radiographic spectrum of findings that may be encountered with the disease. In a patient with unexplained pulmonary symptoms, a history of recent travel to or immigration from an endemic area may be an early clue to the diagnosis of coccidioidomycosis.