Coccidioidomycosis: a growing global concern.

BACKGROUND AND AIM: Climate change is projected to increase the risk of dust storms, particularly in the southwestern US. Research on dust storm impacts is hindered by challenges in dust storm identification. This study assesses the potential link between dust storms and respiratory-related emergency department (ED) visits in the southwestern US. METHODS: We acquired data for 2005-2016 from IMPROVE (Interagency Monitoring of PROtected Environments) monitoring sites in California (n=2), Arizona (n=5), Nevada (n=2), and Utah (n=1). Applying a validated algorithm that identifies dust events of natural origin, dust storm days at each IMPROVE site were identified. We acquired patient-level ED visit data from state agencies and selected visits for respiratory diseases, asthma, and chronic obstructive pulmonary disease (COPD) among patients residing within 50 km of a monitoring site. Using a case-crossover design, we estimated associations of ED visits and dust storms, controlling for meteorology, ozone, and holidays. RESULTS: During 2005-2016, 37 dust storm days occurred at the 10 IMPROVE sites. Mean PM10 and PM2.5 levels were 3-6 times greater on dust compared to non-dust storm days. We observed associations of respiratory ED visits and dust storms, with strongest associations at lag 3 [odds ratio of 1.049 (95% confidence interval: 1.002-1.098)]. Results were driven by Arizona, with an odds ratio for respiratory ED visits of 1.068 (95% confidence interval: 1.008-1.133). Associations for asthma were similar, although with larger uncertainty given fewer ED visits. Associations for COPD were consistent with the null. CONCLUSIONS: Using a monitoring-based exposure metric, we observed associations among respiratory ED visits and dust storms. The results add to growing evidence of the health threat posed by dust storms. The dust storm metric was limited by lack of daily monitoring data; future research will incorporate satellite and models for enhanced dust storm characterization. KEYWORDS: Climate, Dust, PM, Morbidity

Coccidioidomycosis (valley fever) is a systemic fungal infection caused by soil fungi, Coccidioides species, and is associated with significant morbidity and mortality. This infection is endemic in northern Mexico, the southwestern United States, and parts of Central and South America. The risk factors include ethnicity (especially African and Pacific Island ancestry), male gender, and immunosuppression. The primary infection occurs in lungs, but fewer than 40% of patients are symptomatic. Fewer than 1% of infections result in disseminated disease, which may involve any organ. Skeletal infection occurs in 10 to 50% of these patients and is frequently multicentric with axial skeleton involvement. The diagnosis can be confirmed by culture of the organism or visual detection from cytological or histological specimens obtained from sites of disease. A presumptive diagnosis can be made in patients with a compatible illness and a positive serologic test. Imaging plays a significant role in diagnosis and follow-up treatment of musculoskeletal coccidioidomycosis and includes radiography, magnetic resonance imaging, computed tomography, and bone scintigraphy. Skeletal coccidioidomycosis is difficult to treat and frequently requires a combination of medical therapy and surgical debridement. Medical therapy must be continued for a prolonged period of time, potentially for a lifetime in some patients.

This paper studies the phase equilibria in the La/sub 2/O/sub 3/-Y/sub 2/O/sub 3/ system in a wide range of temperatures (1350-2450 degrees C) and concentrations (0-100 mole % Y/sub 2/O/sub 3/). The phase-field boundaries were determined by the method of annealing and quenching with the help of DTA, during the course of which the samples were heated in an inert atmosphere up to 2450 degrees C. The phase composition of the samples was investigated by x-rays and petrographic analysis. The phase diagram of the system was constructed, for which the existence of wide regions of solid solutions based on A-, B-, C-, H-, and X-forms of rare-earth-element oxides, the decrease in the phase-transformation temperature of La/sub 2/O/sub 3/ and Y/sub 2/O/sub 3/ upon introducing a second element, and the presence of a compound of the perovskite structure with a region of homogeneity, formed by a solid-state reaction at 1585 degrees C, are typical.

Disseminated coccidioidomycosis is an uncommon fungal infection primarily observed in immunocompromised individuals. Infection typically occurs when individuals inhale fungal spores in endemic areas such as the southwestern United States and parts of Central and South America. However, globalization has increased the number of reported cases outside endemic areas. Herein, we present an unusual case of coccidioidal meningitis, a rare but fatal complication of disseminated coccidioidomycosis, in an immunocompetent patient who previously resided in an endemic area.

Coccidioidomycosis is a fungal infection endemic in the southwestern United States, Mexico, and parts of Central and South America. While coccidioidomycosis is associated with mostly mild infections in the general population, it can lead to devastating infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Early and accurate diagnosis is important in achieving better clinical outcomes in immunocompromised patients. However, the diagnosis of coccidioidomycosis in SOT recipients can be challenging due to the limitations of diagnostic methods including cultures, serology, and other tests in providing a timely and accurate diagnosis. In this review, we will discuss the available diagnostic modalities and approaches when evaluating SOT recipients with coccidioidomycosis, from the use of conventional culture methods to serologic and molecular testing. Additionally, we will discuss the role of early diagnosis in assisting with the administration of effective antifungal therapy to reduce infectious complications. Finally, we will discuss ways to improve the performance of coccidioidomycosis diagnostic methods in SOT recipients with an option for a combined testing approach.

Diversity of limno-terrestrial tardigrades of the Americas in relation to the Great American Biotic Interchange hypothesis (GABI)

Coccidioidomycosis is a dustborne infection caused by the dimorphic fungus Coccidioides immitis. Infections are endemic to certain regions of the southwestern United States. Most patients with primary pulmonary coccidioidomycosis are asymptomatic. Inhalation of fungal spores is the only established mode of infection, and spores may be carried on dust particles. Coccidioidomycosis is frequently unrecognized as a diagnosis because of the lack of suspicion in a non-endemic area. We described a case of coccidioidomycosis manifesting as a persistent pulmonary mass and diagnosed in Taiwan, a non-endemic area. This patient initially was treated with anti-tuberculosis drugs owing to the presence of necrotizing granulomatous inflammation on repetitive lung biopsies. The diagnosis of coccidioidomycosis was confirmed after wedge resection of the right middle lobe of the lung through minithoracotomy. We also reviewed the related literature concerning the epidemiology, clinical manifestations, diagnosis and treatment of coccidioidomycosis.

Demographics and travel patterns of travelers to Central America, South America and the Caribbean seen in the Boston Area Travel Medicine Network (BATMN)

Background: A variety of studies have examined the prevalence of germline mutations in patients undergoing genetic testing for a wide variety of breast cancer predisposition genes. Many of these studies have focused on patients of Northern European descent, leaving variant prevalence and clinical presentations of patients from underrepresented, and often underserved, populations much less well understood. Our study aimed to examine the prevalence of germline mutations among referred patients from Mexico, Central and South America, as well as a comparative population of Hispanic patients from the United States. Methods: We analyzed a de-identified laboratory-based cohort of patients who had received physician-ordered germline multigene panel test results between December 2014 and June 2019. Inclusion criteria for this study were a personal or family history of breast or ovarian cancer, and either (a) an ordering physician based in Mexico, Central America, or South America, or (b) a Hispanic self-reported ethnicity and a US based ordering physician. For this analysis, Mexican patients were combined with Central Americans. Panel size was per physician discretion, and most (>70%) physicians chose large (at least 20 gene) panels of high- and moderate-risk genes including BRCA1, BRCA2, PALB2, CHEK2, ATM, and TP53, among others. Full gene sequencing and deletion/duplication analysis were performed as described previously [PMID: 26207792] and variants were classified using a framework based on the ACMG/AMP guidelines for variant interpretation [PMID: 28492532]. Results: Of the 25,249 participants who met criteria, 18,513 were self-identified Hispanic-Amercians and 6,736 were non-US participants. Of the non-US group, 6,398 were from South America (including 1200 from Chile and 3781 from Brazil) while 273 were from Mexico and 65 from Central America. Pathogenic or Likely Pathogenic variants were uncovered in 14.4% of all participants, with 1864 findings (representing 7.4% of participants) in BRCA1 or BRCA2, and 1769 (7.0% of participants) in other cancer risk genes. Stratified by location, mutation positive rates were highest among Central (26.9%) and South Americans (19.2%), and lowest among the US Hispanics (12.5%). Based on NCCN guidelines, many of these findings would warrant consideration of a change in care for the patient and/or reflex testing of family members. Conclusions: Cancer patients in Mexico, Central, and South America may have less access to germline genetic testing than patients in (for example) the United States, although our study suggests that Latin American patients and their families can benefit from genetic testing at least at the same rate as Hispanic patients in the US. The higher positive rate among Central and South Americans in this study compared to Hispanic-Americans may be due to referral patterns and cost impact, although this question requires further study. The relative VUS rates between populations, mutation rates for specific clinical presentations, and relevant psychosocial issues also need further study to help maximize the utility of germline genetic testing in Latin America. Citation Format: Stephen E Lincoln, Daniel Pineda-Alvarez, Scott T Michalski, Shan Yang, Edward D Esplin. Germline mutation prevalence among US and non-US Hispanic patients undergoing genetic testing for breast and ovarian cancer predisposition [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-19.

Stål, B. 1995. A synopsis of Jacquinia (Theophrastaceae) in the Antilles and South America. — Nord. J. Bot. 15: 493–511. Copenhagen. ISSN 0107–055X.The genus Jacquinia in the Antilles and South America is revised. Twenty‐two native and one introduced species are recognised. In the Greater Antilles, 11 species (six endemic) occur in Cuba, eight in Hispaniola (two endemic), five in Jamaica (two endemic), and four in Puerto Rico (none endemic). Two species (none endemic) occur in the Lesser Antilles and five (four endemic) in South America. Eighteen species are native to the Antilles and of these one, J. arborea, is shared with Central America and one, J. amzillaris, is shared with South America. No species is shared between South and Central America. One new combination, J. frutescens, is made. Several species are illustrated and distribution maps for all species are presented. A key to the species in the Antilles and South America and an index to all combinations published in Jacquinia are provided.

Coccidioidomycosis (CM) is a fungal infection caused by the inhalation of airborne arthroconidia released by Coccidioides spp. Endemic areas include the southwestern United States, Mexico, and parts of South America. The estimated CM cases exceed 300,000 per year. Current treatment for CM is limited and primarily relies on antifungals such as azoles and Amphotericin B. Moreover, concerns about drug cytotoxicity and rising of azole-resistance underscore the need for alternative or adjunctive immune-based prevention and therapies. This review presents recent advances in immune CM intervention and discusses the potential application of emerging antifungal immunotherapy to treat invasive CM. For preventive vaccination, we reviewed the recent development of subunit protein vaccines and mRNA-based vaccines. Prospects for formulating vaccines with potent adjuvants and delivery systems to enhance protective immunity against CM are also provided. For immunotherapy, we reviewed recent reports of antifungal treatment with immunomodulators, CAR-cells and checkpoint inhibitors. Finally, we discuss the application of experimental animal and in vitro models for advancing vaccine and immunotherapeutic development for CM.

Institutional timberland investment in South and Central America

South America is a major region in the world, which includes many countries on the continent of South America, Central America and Mexico. The historic origin, cultural development, and various populations, which share similar characteristics, are reasons why this major region is also known as Latin America. Psychosocial and economical related problems are prominent in South America. Diverse trauma including loss of cultural values and traditional beliefs, poverty, hunger, discrimination, violence, natural disasters, and poor working and social conditions are influencing mental health. Suicide, as well as suicidal behaviour, is an individualistic phenomenon. However, suicidal actions are multifaceted and cluster-based, and often determined by poor social conditions. Accumulation of negative life events can be triggering factors for suicidal conditions. Cultural differences with regard to style and characteristics can be found in suicides that are committed in both urban and rural areas. In South America particularly, the general beliefs and penalties regarding suicides are quite similar to those of the Judeo-Christian European cultural perspectives. Europe originated legal features (mainly from The Netherlands and Italy) in the nineteenth century are maintained, and can be seen in their respective penal codes. Suicide is not penalized. Suicidal behaviours are referred to either psychiatric or psychological treatment. Uruguayan laws date from 1889, with some adjustments in 1934. The law recognizes and protects the right to life and any stimulus, cooperation or help to any person attempting suicide is punished. In 2006, suicide rates in South America were 6.4/100,000 (Paparamborda 2007). Suicides in different South American countries vary among age groups: adolescents, young people, and the elderly (Granados 1977; World Health Organization 2000). Epidemiologic information on completed suicide is still scarce in South and Central America, and the magnitude of so-called uncertain cases of suicide is not known (Bertolote and Fleischmann 2002).

Coccidioidomycosis is endemic to the southwestern United States. Physicians practicing in nonendemic areas are seldom confronted by the primary pulmonary form of this disease, but the popularity of rapid travel warrants consideration of this diagnostic possibility in the investigation of any unresolved pneumonia. This report describes a patient in whom coccidioidomycosis developed during the course of a brief visit to the Southwest and further records the first known recovery of spherules of Coccidioides immitis from the stool of a patient with the primary pulmonary form of this disease.

On the eve of the struggle for independence from Spain the viceroyalty of New Spain (Mexico) constituted a vast area extending from the Caribbean to the Pacific and from the borders of Guatemala and Chiapas to the huge Eastern and Western Internal Provinces, including the territory later incorporated as the south-western United States. The viceroyalty, with a population in 1814 of 6,122,000 (the United States in 1810 had a population of 7,240,000) accounted for over one-third of the total population of the Spanish overseas empire. Mexico City, the viceregal capital, was the largest city in North or South America and, with a population in 1811 of 168,811, after Madrid, the second largest city in the empire. New Spain was also by far the richest colony of Spain. Its trade through the main port of Veracruz from 1800 to 1809 amounted to an annual average of 27.9 million pesos and in the next decade, between 1811 and 1820, to an annual average of 18 million pesos, divided equally between exports and imports. The colony's total output of goods and services stood in 1800 at approximately 240 million pesos, or roughly 40 pesos per capita . This was only half the per capita production of the United States, at that time, for example, but considerably more than that of any other American colony, Spanish or Portuguese. Agriculture and livestock, which employed approximately 80 per cent of the total labour force, produced about 39 per cent of national resources; manufacturing and cottage industries produced about 23 per cent of total output; trade accounted for 17 per cent; mining for 10 per cent; and the remaining ii per cent came from transportation, government and miscellaneous sources.