Abstract Rationale Coccidioidomycosis is a soil-borne fungal infection endemic to the arid regions of the Southwestern United States, including West Texas. Despite its presence in the region, coccidioidomycosis is not a reportable disease in Texas, which may contribute to limited awareness among providers and delay in diagnosis. A prior study from an endemic region reported a median diagnostic delay of 23 days, with 43% of patients undiagnosed for over one month, emphasizing the challenges of timely recognition even in established endemic areas. Methods We conducted a retrospective review of patients diagnosed with coccidioidomycosis at Medical Center Hospital, a tertiary referral center serving the Permian Basin in West Texas, from April 2017 to December 2024. Cases were identified through electronic medical records using ICD-10 codes B38. Extracted variables included admitting diagnosis, age, sex, race, comorbidities, occupation, disease classification, diagnostic method, and time from admission to diagnosis and to antifungal treatment initiation. Descriptive statistics were applied to summarize demographics and diagnostic timelines. Results We identified a total of 67 confirmed cases of coccidioidomycosis. Most patients presented with pulmonary involvement, categorized as acute pulmonary infections (39%), chronic cavitary pulmonary infections (21%), asymptomatic pulmonary nodules (9%) and extrapulmonary disease (31%). Diagnosis was most established by serological method (64%). 29.9% of patients required ICU admissions prior to confirmed diagnosis. The median time from hospital admission to diagnosis was 6.2 days (IQR 4.9 - 11.3). Acute pulmonary infection cases demonstrated the longest time to confirmed diagnosis (median 7.4 days, IQR 5.4 - 14.59). The median time from admission to antifungal initiation was (4.91 days, IQR 2.94 - 8.65). Only 46.2% of patients received empiric antifungal therapy, defined as treatment initiated more than one day before confirmed diagnosis. Graphical analysis illustrated variation in diagnostic timelines across subtypes of coccidioidomycosis infection. Conclusion Our study demonstrates prolonged diagnostic and treatment initiation times for coccidioidomycosis in an endemic region, with suboptimal empiric therapy initiation. These findings highlight the need for greater clinician awareness and diagnostic capacity to enable earlier recognition and treatment of coccidioidomycosis in West Texas. Disclosure No financial or relevant conflicts of interest to disclose. This abstract is funded by: None
Kim et al. (Fri,) studied this question.