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October, 1950 317

The Distribution of Coccidioidomycosis in

Southern California

JOHN F. KESSEL, Ph.D., MARJORIE BIDDLE, A.B., HAROLD A. TUCKER, M.D.,
and ANTOINETTE YEAMAN, A.B., Los Angeles

During the Second World War the microbiology
SUMMARY laboratory of the Los Angeles County General Hos-
pital was requested to cooperate with certain of the
In coccidioidin skin test surveys among
persons of high school age in Saugus, Canoga military units in laboratory and epidemiologic stud-
ies on coccidioidomycosis. Reports of certain of
Park, Banning and Palm Springs areas the
average incidence of positive reaction was 15 these were made available through the courtesy of
Dr. George A. Young, Jr., then with the California-
per cent. Although considerably less than the
68 per cent incidence reported among high Arizona Maneuver Area, and those data which apply
school students of Kern County, it is high to the southern part of California are included in
enough to indicate pockets of relatively high the distribution map of this report.
endemicity in Southern California below the After Willett and Weiss22 reported that 83 cases
San Joaquin Valley. of coccidioidomycosis developed near Banning,
Histoplasmin tests were performed on most California, the laboratory subsequently performed
of the persons tested with coccidioidin in this coccidioidin test surveys in the high schools of Ban-
ning and Palm Springs in order to determine
survey. The over-all incidence of positive re-
action in the group was 7.6 per cent. Most of whether there was an unusually high incidence of
the subjects with positive reaction to histo- positive reaction among the young adults of these
plasmin gave a history of having previously related areas.
lived in some area in the central United Los Angeles County General Hospital records
States where histoplasmosis is known to be showed that a few. patients with coccidioidomycosis
endemic. had been admitted to the hospital from surround-
A few subjects who had positive reaction to ing counties. These led to a study of the records of
coccidioidin tests and who had lived in areas coccidioidomycosis in county hospitals of those
known to be endemic for coccidioidomycosis counties in order to determine whether such cases
but not for histoplasmosis, also had positive had without doubt originated in the counties. Re-
reaction to histoplasmin. However, the indu- ports of cases from Santa Barbara, Ventura, Los
ration produced was always smaller than that Angeles, Orange, Riverside, San Bernardino, and
caused by the coccidioidin reaction, and there San Diego counties were verified and are included
was minimal confusion in interpreting the in this study.
tests. Los Angeles County General Hospital records also
indicated that cases had originated near Canoga
Park in the San Fernando Valley and suggested this
OR years it was assumed that coccidioidomyco- region as an endemic focus. Seven patients with coc-
sis was acquired almost exclusively in the San cidioidomycosis"l were subsequently admitted to
Joaquin Valley of California; hence the use of its the Los Angeles County General Hospital in the fall
common colloquial name, "San Joaquin Valley Fe- of 1948 from a Los Angeles County probation camp
ver." Other parts of the Pacific Southwest of the near Saugus, which is 12 miles north of San Fer-
United States" 3, 6, 9, 10 eventually were recognized nando.
to be endemic areas and in 1943 the Office of the These observations led to the organization of se-
Surgeon General, U. S. Army, prepared a distribu- rial skin test and serial complement fixation test
tion map of the known and suspected areas of coc- surveys in three probation camps within the county,
cidioidomycosis. In that map, the region of Califor- and also to coccidioidin test surveys in Canoga Park
nia south of the San Joaquin Valley was depicted and Newhall high schools. A similar survey in Los
only as an "area of suspected endemicity." Subse-
Angeles High School, located within the city of Los
quent reports of infection of armed forces person- Angeles, was organized as a control.
nel18' 20, 22 shrowed that coccidioidomycosis occurred
in several widely distributed areas of that region. This report, therefore, includes information on
coccidioidomycosis derived from the following
From the Pathology Laboratory, Los Angeles County
General Hospital and Department of Microbiology, School of sources: (1) Certain reports among the armed
Medicine, University of Southern California, Los Angeles. forces stationed in southern California during the
Aided by a grant from the Research Fund, Los Angeles
County Hospital Attending Staff Association and by a con- Second World War; (2) reports of cases from countv
tribution to the Bacteriology Research Fund, University of
Southern California, by Mr. Lewis S. Rosenstiel. hospital records in Southern California or from