Chest
Volume 76, Issue 5, November 1979, Pages 566-570
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Clinical Investigations
Symptomatic Coccidioidomycosis following a Severe Natural Dust Storm: An Outbreak at the Naval Air Station, Lemoore, Calif.

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Eighteen newly diagnosed cases of symptomatic coccidloidomycosis developed two to four weeks following exposure to a severe natural dust storm. The population at risk consisted of 26,000 residents of the San Joaquin Valley with access to health care at the Naval Hospital, Lemoore, Calif. Eight patients were white, and ten were nonwhite.· The number of cases per 100,000 was estimated to be 36 for the white group and 254 for the nonwhite group.· The disease was disseminated in four patients, and all were from the nonwhite group. One patient with disseminated disease, a black man, died. These data suggest that nonwhites may be relatively more susceptible to acquiring primary disease, in addition to developing disseminated disease. Dust storms of this magnitude must be considered a threat to health for populations living within areas endemic for coccidioidomycosis.

Section snippets

Materials and Methods

Eighteen new cases of symptomatic valley fever were diagnosed at the Naval Hospital, Lemoore, Calif, following a severe natural dust storm that occurred from Dec 20 to 22, 1977. This storm arose from the southeast near Bakersfield, Calif, an area of high endemicity. The storm lasted approximately 48 hours. Visibility during the storm decreased to approximately 0.25 mile. The wind velocity rose to 34 mph. The dust was ubiquitous. It seeped through windows, depositing a layer of dust on car seats

Results

In all 18 cases (nine male and nine female patients), symptoms of valley fever developed within two to four weeks after exposure to the dust storm. Initial symptoms generally consisted of low-grade fever, nonproductive cough, fatigue, and pain in the chest. Eight patients were white, and ten patients were nonwhite (two blacks, two Mexican-Americans, one Oriental, four Filipinos, and one Samoan). There were four cases of disseminated disease (three men and one woman), all in nonwhites (one

Case Reports

The following case reports illustrate the unusual manner in which disseminated disease can occur.

Discussion

A previous study alluded to soil or dust contaminated with C immitis as the “vehicle of natural infection.”1 More recent epidemiologic studies at archaeologic sites have confirmed the relationship between inhalation of fungus-contaminated soil and infection.3, 4, 5 Zoologists whose work brings them into contact with rodent burrows are also likely to become infected.6 Coccidioides immitis has been isolated from samples of air collected during dust storms.7, 8 Smith and Beard1 stated in 1946 that

ACKNOWLEDGMENT

We are grateful for the assistance of David A. Stevens, M.D.; Demosthenes Pappagianis, M.D., PhD; Richard R. Hooper, M.D.; and John N. Galgiani, M.D., in reviewing this manuscript and for the secretarial assistance of Mrs. Donna Sparlin and Mrs. Carolyn Kink.

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The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or necessarily reflecting the views of the Bureau of Medicine or of the Naval Service at large.

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