The aetiological agents of coccidioidomycosis, Coccidioides immitis and C posadasii, inhabit ecological niches found only in the western hemisphere, primarily in the southwestern deserts of the US (California, Arizona, New Mexico, and western Texas) and northern deserts of Mexico.[3] Limited areas of Utah, Nevada, and eastern Washington state, as well as Central and South America are also endemic. Coccidioidomycosis is an infection identified primarily in people residing within these areas; cases outside the endemic areas may be identified in visitors returning to non-endemic areas. Approximately 150,000 cases of coccidioidomycosis occur in the US annually.[4] More than half of these cases occur in Arizona,[5]although cases in California have increased since 2010.[6][7] In 2017, the reported prevalence of coccidioidomycosis infection in the US was 14,464 cases, with 6885 cases in Arizona and 6925 cases in California.[6] The reasons for this drop in reported cases is not fully understood, but suggestions include changes to: the number of people exposed to Coccidioides (owing to travel or relocation); environmental factors affecting fungal growth and circulation (such as temperature and rainfall); the way cases are detected and reported.[6]

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