Chang Douglas C, Anderson Shoana, Wannemuehler Kathleen, Engelthaler David M, Erhart Laura, Sunenshine Rebecca H, Burwell Lauren A, Park Benjamin J
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Emerg Infect Dis. 2008 Jul;14(7):1053-9. doi: 10.3201/eid1407.070832.
Coccidioidomycosis is a common cause of community-acquired pneumonia (CAP) in disease-endemic areas. Because testing rates influence interpretation of reportable-disease data and quality of CAP patient care, we determined the proportion of CAP patients who were tested for Coccidioides spp., identified testing predictors, and determined the proportion of tested patients who had positive coccidioidomycosis results. Cohort studies to determine the proportion of ambulatory CAP patients who were tested in 2 healthcare systems in metropolitan Phoenix found testing rates of 2% and 13%. A case-control study identified significant predictors of testing to be age >/=18 years, rash, chest pain, and symptoms for >/=14 days. Serologic testing confirmed coccidioidomycosis in 9 (15%) of 60 tested patients, suggesting that the proportion of CAP caused by coccidioidomycosis was substantial. However, because Coccidioides spp. testing among CAP patients was infrequent, reportable-disease data, which rely on positive diagnostic test results, greatly underestimate the true disease prevalence.
球孢子菌病是疾病流行地区社区获得性肺炎（CAP）的常见病因。由于检测率会影响可报告疾病数据的解读以及CAP患者的护理质量，我们确定了接受球孢子菌检测的CAP患者比例，识别了检测的预测因素，并确定了球孢子菌病检测结果呈阳性的患者比例。在队列研究中，为了确定在大都市凤凰城的2个医疗系统中接受检测的门诊CAP患者比例，发现检测率分别为2%和13%。一项病例对照研究确定检测的显著预测因素为年龄≥18岁、皮疹、胸痛以及症状持续≥14天。血清学检测在60例接受检测的患者中有9例（15%）确诊为球孢子菌病，这表明由球孢子菌病引起的CAP比例相当可观。然而，由于在CAP患者中对球孢子菌的检测并不常见，依赖阳性诊断检测结果的可报告疾病数据大大低估了该病的实际患病率。
