What demographics are at higher risk for meningeal Coccidiomycosis dissemination?

Demographics of Meningeal Coccidioidomycosis Dissemination

Patients of African, Filipino, Hispanic, and Asian (especially Pacific Islander) ancestry are at substantially higher risk for meningeal coccidioidomycosis dissemination, with males affected twice as often as females. 1, 2

High-Risk Ancestral Groups

The most critical demographic risk factor is ancestry, with specific populations showing markedly elevated rates of dissemination:

• African Americans have the highest risk for disseminated coccidioidomycosis, with particular predilection for bony involvement, though meningeal disease also occurs frequently 3, 4
• Filipino patients demonstrate the highest risk for meningeal dissemination specifically, with 30% of Filipino patients with pulmonary disease progressing to disseminated disease, often involving the central nervous system 3
• Hispanic populations show increased susceptibility to disseminated forms, including meningeal involvement 1, 2, 5
• Asian ancestry, particularly Pacific Islanders, carries elevated risk for meningeal complications 2, 5

These ancestral risk factors represent true biological susceptibility, not merely socioeconomic markers, though the immunologic mechanism remains unclear 4.

Sex Distribution

• Males are affected twice as frequently as females (2:1 male predominance) in meningeal coccidioidomycosis 2
• Male sex modestly increases risk of disseminated infection, though not to the degree seen with specific ancestries 1

Immunocompromised States

Patients with impaired cellular immunity face dramatically elevated risk:

• HIV/AIDS patients are at highest risk, with dissemination rates as high as 75% compared to the baseline 1% risk in immunocompetent individuals 1, 2
• Chronic corticosteroid therapy significantly increases risk for meningeal involvement 2
• Patients with specific gene mutations affecting interferon-γ, IL-12, and other cellular immune pathways show progressive coccidioidal infections with dissemination risk approaching 75% 1

Age Considerations

While the guidelines do not specify age as a primary risk factor for meningeal dissemination specifically, the disease can affect all age groups who are exposed in endemic areas 1.

Important Clinical Caveats

• Diabetes does NOT increase risk for meningeal dissemination, though diabetic patients are more prone to pulmonary complications 1, 2
• Socioeconomic status and race appear as risk markers rather than independent risk factors when controlling for other variables such as exposure, access to care, and living conditions 1
• Even short-term travel to endemic regions can result in acquisition of meningeal disease, making awareness important even in non-endemic areas 2
• Immunocompetent Caucasian patients can develop disseminated disease, though this is atypical and less common than in high-risk ancestral groups 5

Geographic and Occupational Context

• Rural agricultural workers in endemic areas (particularly Central Valley, California and southern Arizona) represent a substantial proportion of cases, often with barriers to care including poverty, low health literacy, and medication nonadherence 6
• Military personnel stationed in endemic areas face exposure risk, with ethnically diverse forces including susceptible members of African, Filipino, Hispanic, and Asian ancestry 5