Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020

Alexandra K. Heaney; Jennifer R. Head; Kelly Broen; Karen Click; John Taylor; John R. Balmes; Jon Zelner; Justin V. Remais


Emerging Infectious Diseases. 2021;27(5):1266-1273. 

In This Article

Abstract and Introduction


We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.


Persons with coronavirus disease (COVID-19) can have a wide range of symptoms, including cough, difficulty breathing, and fatigue.[1] These symptoms are also common among patients with coccidioidomycosis,[2] a primarily pulmonary disease caused by inhalation of Coccidioides, a soil-dwelling dimorphic fungi. These spores spread through the air, especially through wind erosion in dusty environments and dirt disrupting activities such as digging or construction. Coccidioides spores are found in hot and arid environments, including much of the southwestern United States, where coccidioidomycosis incidence has been increasing. Since 2016, California has recorded its highest incidences of coccidioidomycosis.[3,4]

We reviewed epidemiologic and clinical literature on coccidioidomycosis and COVID-19 to identify subpopulations that might be at risk for co-infection and severe disease. We discuss how the COVID-19 pandemic might affect coccidioidomycosis diagnosis, surveillance, and clinical management. We also evaluate evidence that co-infection might contribute to severe COVID-19 or reactivation of latent Coccidioides infection. Our study informs healthcare providers, policymakers, and populations in regions to which coccidioidomycosis is endemic on potential interactions between this disease and COVID-19, encouraging protective measures and prompt diagnosis.