Testing for Coccidioidomycosis among Patients with Community-Acquired Pneumonia
Author Information
Author(s): Chang Douglas C., Anderson Shoana, Wannemuehler Kathleen, Engelthaler David M., Erhart Laura, Sunenshine Rebecca H., Burwell Lauren A., Park Benjamin J.
Primary Institution: Centers for Disease Control and Prevention
Hypothesis
What is the proportion of community-acquired pneumonia patients tested for Coccidioides spp. and what are the predictors of testing?
Conclusion
Testing for Coccidioides spp. among ambulatory patients with community-acquired pneumonia is infrequent in metropolitan Phoenix, leading to underdiagnosis of coccidioidomycosis.
Supporting Evidence
- Only 2% of patients in system A were tested for Coccidioides spp. compared to 13% in system B.
- 15% of tested patients had positive results for coccidioidomycosis.
- Testing predictors included age over 18, rash, chest pain, and symptoms lasting more than 14 days.
Takeaway
Doctors should test patients with pneumonia for a disease called coccidioidomycosis, especially in areas where it's common, because many cases are missed.
Methodology
The study involved retrospective cohort studies and a case-control study to evaluate testing practices and predictors among patients with community-acquired pneumonia.
Potential Biases
Potential bias due to differences in testing practices between healthcare systems and lack of socioeconomic data.
Limitations
The study's definition of pneumonia included patients without a chest radiograph, which may not reflect true cases, and the findings may not be generalizable to other areas.
Participant Demographics
In system A, 19% white, 6% black, 69% Hispanic; system B had mostly privately insured patients.
Statistical Information
P-Value
p<0.05
Confidence Interval
95% CI 3%–20%
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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