Coccidioidomycosis, which is a fungal infection caused by Coccidioides immitis, is endemic in the southwestern United States, including the San Joaquin Valley in California, and regions of Central and South America.1 Prevalence studies indicate that more than one third of the population in endemic areas is infected, but the primary infection remains asymptomatic in 50% of these individuals.1 Up to 20% of cases occurring yearly are diagnosed outside endemic areas.2 For unknown reasons, males, pregnant women, and darker-skinned races are more susceptible to both primary and disseminated coccidioidomycosis.3 For example, Filipinos are 175 times and blacks 14 times more likely to become infected than whites. Dissemination is 10 times more likely in these populations.4
Quiz Case 2. Arch Otolaryngol Head Neck Surg. 1999;125(10):1159–1162. doi:
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