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 ICD10 codes for pneumonia (J18.*) or erythema nodosum (L52) between 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 to 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 greater than 45% within and between years. Coccidioidomycosis was a common cause of erythema nodosum (65%, 95% confidence: 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 healthcare organizations can augment surveillance of diseases important to public health.
Keywords: Pneumonia; coccidioidomycosis; erythema nodosum; quality improvement.
Copyright © 2024. Published by Elsevier Inc.