Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020

Abstract

We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.

Keywords: Arizona; COVID-19; California; Coccidioides; SARS-CoV-2; United States; co-infections; coccidioidomycosis; coronavirus disease; coronaviruses; diagnosis; fungi; respiratory infections; risk factors; severe acute respiratory syndrome coronavirus 2; viruses; zoonoses.

Figure 1

County-level incidence of (A) coronavirus disease (COVID-19) in 2020 and (B) coccidioidomycosis in 2019, California and Arizona. COVID-19 incidence reflects cumulative case count as of August 14, 2020 (5). Coccidioidomycosis incidence reflects annual incidence in 2019 (6,7). Shading indicates levels of incidence. Brackets indicate inclusive bounds; parentheses indicate exclusive bounds.

Figure 2

Scatterplot of county-level incidence of COVID-19 in 2020 and coccidioidomycosis in 2019, California and Arizona. R² = 0.259; p<0.01.