Mold Remediation >> Mold Symptoms

Kern County, in the San Joaquin Valley, California, is one of the most highly coccidioidomycosis-endemic regions. The number of new cases of coccidioidomycosis in the area has varied widely from year to year; a low incidence of coccidioidomycosis from 1987 to 1990 (<500 reported cases a year in Kern County), Mold Symptoms was followed by a high incidence from 1991 to 1994. 

The number of reported cases, Mold Symptoms which were identified by serologic testing at the Kern County Health Department (the reference serology laboratory for the county), probably represent approximately 10% of the total number of infected persons in that county (Figure 4) (28). The medical costs for infected persons in Kern County are estimated at $66 million(29). 

In 1992, 4,500 new cases were reported to the California State Department of Health Services (30), Mold Symptoms most from Kern County; the number of new cases also increased in almost all counties in central and southern California (30). The increase in reported cases in California in 199192 was dramatic but certainly an underestimate of the magnitude of the problem (31). 

The epidemic seems to be waning, Mold Symptoms for reasons that are not clear, but the marked increase in incidence from the 1980s to 1991 through 1993 is indisputable. What factors may account for this increase? One major consideration is the weather. C. E. Smith observed years ago that the number of cases of coccidioidomycosis was higher in the summer after a rainy winter than after a dry winter (10). 

In March 1991, Mold Symptoms a 5-year drought in California ended with a heavy rainfall. Rainfall was also heavy in the winters of 1992 and 1993. Though the relationship between the weather and the density of C. immitis in the soil may never be understood in detail, the following scenario seems plausible. During drought years, the number of organisms competing with C. immitis decreases. C. immitis does not thrive, but it remains viable though dormant. 

After heavy rain, the arthrocondia germinate and multiply to a higher density than usual because of the lack of competing organisms. Once the soil dries in the late summer and fall, Mold Symptoms the arthroconidia become airborne and potentially infectious (29). Another reason for the sudden increase in disease incidence might have been the number of susceptible persons in the disease-endemic area. 

The number may have been the result of both increased migration of susceptible persons and decreased immunity in the indigenous population. Immunity comes from prior infection and is manifest as a positive coccidioidin skin test. In almost all cases, Mold Symptoms coccidioidomycosis confers lifelong immunity. 

As a result of years of low incidence, the number of nonimmune persons may have increased, Mold Symptoms as evidenced by the decrease in prevalence of positive coccidioidin skin tests among local high school students. In 1939, 50% to 60% of high school students in the San Joaquin Valley had positive skin tests(17), but in the 1980s only 3% to 5% of high school students had positive skin tests (T. Larwood, pers. comm.). 

Given the historical data, this estimate seems low, but another study also found a low prevalence. In 1985, workers in Tucson estimated that 30% of a random sample of persons in a Hispanic neighborhood had positive skin tests (32). In addition to the drought, Mold Symptoms irrigation of fields, the increasing amount of land under cultivation, and a decrease in indoor dust due to the widespread use of air conditioning may also have played a role in the relatively low incidence of infections in the 1980s. 

Coccidioidomycosis in the Immunosuppressed C. immitis is a primary pathogen that can cause disease in immunologically healthy persons. In the population as a whole, Mold Symptoms fewer than 5% of infected persons have persistent pulmonary infection or extrapulmonary dissemination of the disease (16). The incidence of clinically significant disease in immunosuppressed patients is much higher. 

In one study symptomatic coccidioidomycosis developed in 18 (7%) of 260 renal transplant patients in Arizona over a 10-year period, Mold Symptoms primarily in the first year after transplantation (33). This rate was substantially higher than the rate of infection in patients who were undergoing hemodialysis. Approximately 12 (67%) of infections in the patients with renal transplants were disseminated; the remainder were confined to the lung. 

Of patients with disseminated disease, 10 (83%) died, Mold Symptoms despite intensive therapy with amphotericin B. In another study from Tucson, all confirmed cases of coccidioidomycosis during a 4-year period were reviewed. The dissemination rate was 8 (73%) of 11 of patients who were receiving immunosuppressive therapies, compared with only 15 (14%) of 110 healthy controls. 

As more patients in the disease-endemic area receive liver, lung, and heart transplants, this problem will increase. Pregnant women, Mold Symptoms especially those in the third trimester, are at high risk for developing disseminated coccidioidomycosis if they become infected (24). In the first and second trimesters, the risk is much lower. 

The reason is not entirely clear, but two factors may play a role: 1) the high sex hormone levels found in late pregnancy enhance the growth of C. immitis in vitro (25), and 2) the shift in the T-cell immune response late in pregnancy toward TH2 cytokines (26)interferes with resolving the infection. In experimental animals, Mold Symptoms pregnancy increases the severity of leishmaniasis, another infection hat is controlled by a TH1 T-cell response.

Coccidioidomycosis in AIDS patients is also very likely to be life-threatening. The first cases of coccidioidomycosis described in AIDS patients were atypical, Mold Symptoms with a reticulonodular chest x-ray pattern, positive blood cultures, and infection of multiple organs (36). As we have gained more experience with coccidioidomycosis in HIV-infected persons, we have learned that the clinical spectrum is broader than originally reported. 

Fish Mold Symptoms and his colleagues collected data from 77 AIDS patients with coccidioidomycosis who were treated by physicians in Arizona and California (37). They grouped the patients according to their clinical symptoms.

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