ABSTRACT
B. Geographic Distribution Coccidioidomycosis is primarily found in the desert regions of Southern California, Arizona, Nevada, New Mexico, and west Texas (Fig. 2). This large area is home to ~20% of the population of the United States. It also includes some of the most rapidly expanding cities in the nation and attracts large numbers of visitors each year. The urban perimeters are extending further into the desert, as exemplified by the Bakersfield region of California and the Phoenix-Tucson area of Arizona. However, many cases of coccidioidomycosis are also found in regions that are not hyperendemic, such as San Diego and Los Angeles. Outbreaks of coccidioidomycosis have been reported among archaeology students digging in prehistoric Indian sites in northern California [7,8]. In 1977, a major dust storm blew soil from the San Joaquin Valley to northern California, including San Francisco, Marin County, Santa Clara, and Monterey County. Immediately following the storm, many cases of coccidioidomycosis were reported in nonendemic regions of middle and northern California [9]. At the time, there was some concern that C. immitis might be able to seed and persist in the soil in these areas, but that has not occurred.
