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Access to Urgent Care Practices Improves Understanding and Management of Endemic Coccidioidomycosis: Maricopa County, Arizona, 2018-2023 - 25/09/24

Doi : 10.1016/j.amjmed.2024.04.028 
John N. Galgiani, MD a, b, , Anqi Lang, MS c, Brandon J. Howard, MPH d, Jie Pu, MS c, Irene Ruberto, PhD, MPH e, Lia Koski, DPH d, Jennifer Collins, MPH d, Esteban Rios, MS f, Thomas Williamson, MPH e
a The Valley Fever Center for Excellence, Department of Medicine, and the Department of Immunobiology, College of Medicine-Tucson, University of Arizona, Tucson 
b The BIO5 Institute, University of Arizona, Tucson 
c Department of Data Analytics, Banner Health System, Phoenix, Ariz 
d Maricopa County Department of Public Health, Phoenix, Ariz 
e Arizona Department of Health Services, Phoenix 
f School of Osteopathic Medicine, A.T. Still University, Phoenix, Ariz 

Requests for reprints should be addressed to John N. Galgiani, MD, The Valley Fever Center for Excellence, Department of Medicine, College of Medicine-Tucson, PO Box 245215 1656 E Mabel St., Tucson, Ariz 85724.The Valley Fever Center for ExcellenceDepartment of MedicineCollege of Medicine-TucsonPO Box 245215 1656 E Mabel St.TucsonAriz85724

Abstract

Background

Coccidioidomycosis within endemic regions is often undiagnosed because appropriate testing is not performed. A dashboard was developed to provide information about the prevalence of coccidioidomycosis throughout the year.

Methods

Banner Urgent Care Service has many clinics within Maricopa County, Arizona, a highly endemic region for coccidioidomycosis. All clinic visits and subset analyses for patients with International Classification of Diseases, Tenth Revision codes for pneumonia (J18.*) or erythema nodosum (L52) during 2018-2024 were included. Tabulated were daily frequencies of visits, pneumonia and erythema nodosum coding, coccidioidal testing, and test results. Banner Urgent Care Services’ counts of monthly coccidioidomycosis diagnoses were compared with those of confirmed coccidioidomycosis cases reported to Maricopa County Department of Public Health.

Results

Monthly frequencies of urgent care coccidioidomycosis diagnoses strongly correlated with public health coccidioidomycosis case counts (r = 0.86). Testing frequency for coccidioidomycosis correlated with overall pneumonia frequency (r = 0.52). The proportion of pneumonia due to coccidioidomycosis varied between <5% and >45% within and between years. Coccidioidomycosis was a common cause of erythema nodosum (65%; 95% confidence interval, 45%-67%) and independent of pneumonia. Over half of Banner Urgent Care Services’ coccidioidomycosis diagnoses were coded for neither pneumonia nor erythema nodosum.

Conclusion

Data provided by the coccidioidomycosis dashboard can assist urgent care practitioners in knowing when coccidioidomycosis is prevalent in the community. Patients with exposure to endemic coccidioidomycosis who develop erythema nodosum or pneumonia should routinely be tested for coccidioidomycosis. Data from private health care organizations can augment surveillance of diseases important to public health.

El texto completo de este artículo está disponible en PDF.

Keywords : Coccidioidomycosis, Erythema nodosum, Pneumonia, Quality improvement


Esquema


 Funding: None.
 Conflicts of Interest: None.
 Authorship: All authors had access to the data and a role in writing the manuscript. JNG: Writing – review & editing, original draft, Visualization, Validation, Supervision, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization; AL: Validation, Software, Resources, Methodology, Data curation; BJH: Writing - review & editing, Methodology, Data curation; JP: Writing – review & editing, Resources, Methodology, Data curation; IR: Writing – review & editing, Formal analysis; LK: Writing – review & editing; JC: Writing – review & editing; ER: Investigation; TW: Writing – review & editing, Methodology.


© 2024  Elsevier Inc. Reservados todos los derechos.
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Vol 137 - N° 10

P. 951-957 - octobre 2024 Regresar al número
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