Coccidioidomycosis in Northern Arizona: an Investigation of the Host, Pathogen, and Environment Using a Disease Triangle Approach

Heather L. Mead, Daniel R. Kollath, Marcus de Melo Teixeira, Chandler C. Roe, Carmel Plude, Nivedita Nandurkar, Chelsea Donohoo, Brettania L.W. O'Connor, Joel Terriquez, Paul Keim, Bridget M. Barker

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Coccidioides immitis and Coccidioides posadasii are the etiological agents of coccidioidomycosis (Valley fever [VF]). Disease manifestation ranges from mild pneumonia to chronic or extrapulmonary infection. If diagnosis is delayed, the risk of severe disease increases. In this report, we investigated the intersection of pathogen, host, and environment for VF cases in Northern Arizona (NAZ), where the risk of acquiring the disease is much lower than in Southern Arizona. We investigated reported cases and assessed pathogen origin by comparing genomes of NAZ clinical isolates to isolates from other regions. Lastly, we surveyed regional soils for presence of Coccidioides. We found that cases of VF increased in NAZ in 2019, and Coccidioides NAZ isolates are assigned to Arizona populations using phylogenetic inference. Importantly, we detected Coccidioides DNA in NAZ soil. Given recent climate modeling of the disease that predicts that cases will continue to increase throughout the region, and the evidence presented in this report, we propose that disease awareness outreach to clinicians throughout the western United States is crucial for improving patient outcomes, and further environmental sampling across the western U.S. is warranted.

Original languageEnglish (US)
Issue number5
StatePublished - Sep 2022


  • Northern Arizona
  • Southwestern United States
  • Valley fever
  • coccidioides
  • disease triangle
  • endemic mycoses
  • environmental microbiology
  • phylogenetic analysis

ASJC Scopus subject areas

  • Microbiology
  • Molecular Biology


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