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318 CALIFORNIA MEDICINE Vol. 73, No. 4

physicians within the area, these reports having after injection. The results were scaled as follows:
been checked to determine whether or not the pa- 1+, = 5 to 9 mm. induration
tient was a permanent resident of the area; (3) an 2+, = 10 to 14 mm. induration
outbreak of coccidioidomycosis in a Los Angeles 3+, = 15 or more mm. induration
County probation camp near Saugus, together with 4+, = 15 or more mm. induration plus necrosis.
serial skin test surveys made in this camp and in Erythema alone was not regarded as a positive reaction.
two other camps within the county; (4) skin test RESULTS AND DISCUSSION
surveys in five different high schools within the area Coccidioidomycosis
(see map and Table 1).
Recent reports in the medical literature2 5,16,17, 21 The results of the coccidioidin surveys are sum-
on the distribution of histoplasmosis as based on marized in Table 1. Of the 1,058 persons tested, 122
(11.5 per cent) had positive reaction. The range for
histoplasmin surveys and questions relating to the the groups tested varied from 4 per cent in the Los
specificity of the coccidioidin and histoplasmin reac- Angeles High School to 20 per cent in the Banning
tions suggested the desirability of performing histo- and Palm Springs high schools. Since it was desired
plasmin tests. These were performed on 984 of the to determine the incidence of coccidioidin reactors
individuals tested in the course of this study (see
Table 2). who had acquired sensitivity in each area studied,
careful histories of past and current residence in
The histoplasmin used was from Lot H3 prepared areas previously established for either coccidioido-
by Dr. C. W. Emmons of the National Institutes of mycosis or histoplasmosis were taken from each one
Health, and was furnished through the courtesy of tested.
Dr. C. E. Palmer. It was used in a dilution of The persons tested were separated into two groups
1:1,000. (Table 1), one group comprising those with pre-
The coccidioidin was from Lot Al prepared in vious residence in an area in which coccidioidomy-
the Los Angeles County Hospital Laboratory by cosis was endemic, the other comprising those who
methods described by Kessel and co-workers.10 It had not resided in a known endemic area. "Resi-
was used in a dilution of 1:100. dence," in this presentation, indicates residence of
One-tenth cubic centimeter of each antigen was more than one month in a known endemic area. A
injected intracutaneously into the flexor surface of majority of the reactors had resided at some time in
the forearm, and the results were observed 48 hours areas previously recognized to be endemic; in this

COCCIDIOIDOMYCOSIS IN SOUTHERN CALIFORNIA

KERN

12@
13
SAN BERNARDINO
I
* CASES
SKIN TESTLSURVEYS EN

1. CAMP ROBERTS 14. SAN
2. LOMPOC BERNARDINO
3'EL RIO 15. COLTON RIVERSIDE
4.FILMORE 16. RIVERSIDE
5-MOORPARK 17. BANNING
6.SUSANA KNOLLES 18. PALM SPRINGS
7.CANOGA PARK 19.ORANGE COUNTY
BLOB ANGELES 20. LAKE ELSINORE
9-SAUGUS 21. BLYTHE
10. LANCASTER 22. SAN DIEGO
I 1. MOHAVE 23. EL CAJON
12.BARSTOW 24. WINTER HAVEN
13. NEEDLES