Abstract
Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.
Coccidioidomycosis, also known as Valley fever, is a fungal infection endemic to the southwestern United States and Mexico (1); it typically manifests as a respiratory syndrome (2). Without specific laboratory confirmation, coccidioidomycosis cannot be distinguished from community-acquired pneumonia (3,4). However, the necessary tests are conducted for <13% of patients with community-acquired pneumonia in urban Arizona ambulatory clinics (5) and 2.8% of patients in emergency departments (6). Until coccidioidomycosis is correctly diagnosed, patients are likely receive unnecessary antibacterial drugs, laboratory tests, imaging, and invasive procedures, all of which could contribute to unnecessary costs and additional adverse health consequences. The extent to which there is a delay in coccidioidomycosis diagnosis and how much healthcare utilization occurs with that delay is uncertain.
We report a retrospective study within metropolitan Tucson, Arizona, USA, an area in which coccidioidomycosis is highly endemic, to determine the delay for patients from the date when they first sought care to the date they received a laboratory-confirmed coccidioidomycosis diagnosis. We also analyzed healthcare costs, efforts, and antibacterial drug use within that period.
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