A Localized Epidemic of Coccidioidal Infection

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Abstract
THE coccidioidal endemic areas have been fairly well defined, and the geographic boundaries in the southwestern United States are known.1 Most heavily contaminated are the southern San JoaquinValley in central California and the Phoenix–Tucson area in Arizona. Within these areas the pattern of contamination of the soil by Coccidioides immitis is not uniform but appears to be concentrated in somewhat isolated locales,2 3 4 5 owing to variation in the environmental factors that encourage or discourage the growth of the pathogenic fungus in a particular area.6 A similar situation has been demonstrated with histoplasmosis when localized epidemics occur where soil conditions are . . .