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Adult outpatients with unspecified community-acquired pneumonia (CAP) rarely receiveĀ diagnostic testing for blastomycosis, coccidioidomycosis, or histoplasmosis, however repeat visits seem to drive this testing, according to a retrospective study of commercial insurance claims published in JAMA Network Open. Among 573,994 CAP patients seen from 2017ā2023, only 5% underwent diagnostic testing for blastomycosis, coccidioidomycosis, or histoplasmosis, and those tests typically occurred after a median of 3 patient visits. Of those tested, 3% received a fungal disease diagnosis with coccidioidomycosis being most common. Testing rates varied widely across the country. States with the highest proportion of patients who received diagnoses were Arizona (344 patients [23%]), New Mexico (4 patients [11%]), California (174 patients [10%]), Montana (1 patient [5%]), and Minnesota (12 patients [5%]). Clinical features such as rash, chest pain, lymphadenopathy, weight loss, and receipt of multiple antibiotic classes were associated with increased odds of fungal diagnoses.Ā
Something to consider: Authors say itās important to consider blastomycosis, coccidioidomycosis, and histoplasmosis because CAP is a common presentation for each of these fungal diseases, while noting that patients may experience diagnostic delays often for more than 1 month. Low recognition can also contribute to inappropriate antibiotic use. āNearly one-third of patients with unspecified CAP received antibiotics from multiple classes, possibly signifying a lack of symptom resolution after 1 antibiotic course and indicating that these patients likely fit the criteria for consideration of fungal disease testing, given that nearly every continental U.S. state is endemic for at least 1 of these diseases,ā the authors say.