Is coccidioidomycosis endemic in Africa? An unusual finding from Nigeria.

Coccidioidomycosis, also known as valley fever, is one of the classical endemic mycosis. It is an infection caused by Coccidioides. This fungus is known to live in soil in the southwestern United states and parts of Mexico and Central and South America. Thus coccidioidomycosis is thought to occur only in the Western hemisphere.

But is this really so? A recent case report in the Annals of Tropical Pathology proves contrary to this long-held belief. The authors reported a case of cutaneous coccidioidomycosis in a 28 year old HIV positive woman in Borno state, North-eastern Nigeria. The patient had never traveled to areas of known endemicity for the disease. The diagnosis was made on histopathology said to show the characteristic spherules and the patient was treated with fluconazole.

While the case is unusual, it calls for greater surveillance and epidemiological research. Another endemic mycosis, classical histoplasmosis, which was once thought to be confined to the Ohio and Misissippi valley areas of USA, has been increasingly diagnosed in many countries in other continents and is considered a neglected disease in Africa. Coccidioidomycosis might be no different.


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