{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:01:27Z","timestamp":1783036887645,"version":"3.54.6"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Blastomycosis, coccidioidomycosis, and histoplasmosis cause various symptoms and syndromes, which may present similarly to other infections such as bacterial or viral community-acquired pneumonia, influenza, and tuberculosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used the IBM MarketScan Research Databases to identify adult outpatients with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), diagnosis codes during 2016\u20132017 for blastomycosis, coccidioidomycosis, histoplasmosis, pneumonia (viral, bacterial, Streptococcus pneumoniae, and unspecified pneumonia), influenza; tuberculosis, and other lower and upper respiratory infections. We compared symptoms on and in the 90 days before diagnosis between patients with these diagnosis codes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fever was less common in blastomycosis (2.6%), histoplasmosis (5.3%), and coccidioidomycosis (9.4%) than in patients with influenza (18.5%) or pneumonia (12.6\u201316.3%). Fungal diseases resembled bacterial, viral, and unspecified pneumonias for many pulmonary symptoms. However, cough was more common with coccidioidomycosis (31.4%) and less common with histoplasmosis (14.0%) and blastomycosis (13.1%) versus influenza (20.2%). Although less frequent, solitary pulmonary nodule (5.2\u201314.4%), enlarged lymph nodes (3.7\u20139.0%), hyperhidrosis (&amp;lt;2%), and erythema nodosum (&amp;lt;2%) were particularly suggestive of fungal diseases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite limitations inherent in administrative coding, this analysis of symptom codes across disease types suggests that fungal diseases may be difficult to clinically distinguish from other causes of pneumonia except when certain uncommon symptoms are present. Healthcare providers caring for patients with pneumonia, especially if nonresponsive to conventional treatment, should consider fungal diseases as possible etiologies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1554","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T19:20:41Z","timestamp":1602184841000},"page":"e4336-e4344","source":"Crossref","is-referenced-by-count":33,"title":["Symptoms in Blastomycosis, Coccidioidomycosis, and Histoplasmosis Versus Other Respiratory Illnesses in Commercially Insured Adult Outpatients\u2014United States, 2016\u20132017"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-2493","authenticated-orcid":false,"given":"Kaitlin","family":"Benedict","sequence":"first","affiliation":[{"name":"National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miwako","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha","family":"Garg","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Chiller","sequence":"additional","affiliation":[{"name":"National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan R","family":"Jackson","sequence":"additional","affiliation":[{"name":"National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"2021121011285680900_CIT0001","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/cid\/ciw538","article-title":"Executive summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the treatment of coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2021121011285680900_CIT0002","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1086\/521259","article-title":"Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America","volume":"45","author":"Wheat","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2021121011285680900_CIT0003","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1086\/588300","article-title":"Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America","volume":"46","author":"Chapman","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2021121011285680900_CIT0004","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.rmed.2012.02.004","article-title":"Endemic mycoses: overlooked causes of community acquired pneumonia","volume":"106","author":"Hage","year":"2012","journal-title":"Respir Med"},{"key":"2021121011285680900_CIT0005","doi-asserted-by":"crossref","first-page":"958","DOI":"10.3201\/eid1206.060028","article-title":"Coccidioidomycosis as a common cause of community-acquired pneumonia","volume":"12","author":"Valdivia","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"2021121011285680900_CIT0006","doi-asserted-by":"crossref","first-page":"ofw078","DOI":"10.1093\/ofid\/ofw078","article-title":"Diagnostic delay and antibiotic overuse in acute pulmonary blastomycosis","volume":"3","author":"Alpern","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"2021121011285680900_CIT0007","first-page":"1003","article-title":"Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States","volume":"70","author":"Benedict","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021121011285680900_CIT0008","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1053\/adpa.2002.34575","article-title":"Blastomycosis: the great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients","volume":"6","author":"Lemos","year":"2002","journal-title":"Ann Diagn Pathol"},{"key":"2021121011285680900_CIT0009","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3201\/eid1563.081007","article-title":"Coccidioidal pneumonia, Phoenix, Arizona, USA, 2000-2004","volume":"15","author":"Kim","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"2021121011285680900_CIT0010","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1378\/chest.20.6.588","article-title":"Coccidioidomycosis; a review","volume":"20","author":"Trimble","year":"1951","journal-title":"Dis Chest"},{"key":"2021121011285680900_CIT0011","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0272-5231(05)70232-X","article-title":"Fungal pneumonias: the endemic mycoses","volume":"20","author":"Goldman","year":"1999","journal-title":"Clin Chest Med"},{"key":"2021121011285680900_CIT0012","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/00325481.1956.11691299","article-title":"The clinical diagnosis of histoplasmosis","volume":"20","author":"Furcolow","year":"1956","journal-title":"Postgrad Med"},{"key":"2021121011285680900_CIT0013","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3201\/eid1611.100475","article-title":"Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007-2008","volume":"16","author":"Tsang","year":"2010","journal-title":"Emerg Infect Dis"},{"key":"2021121011285680900_CIT0014","doi-asserted-by":"crossref","first-page":"e0230305","DOI":"10.1371\/journal.pone.0230305","article-title":"Presumed ocular histoplasmosis syndrome in a commercially insured population, United States","volume":"15","author":"Benedict","year":"2020","journal-title":"PLoS One"},{"key":"2021121011285680900_CIT0015","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciy866","article-title":"Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza","volume":"68","author":"Uyeki","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2021121011285680900_CIT0016","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"2021121011285680900_CIT0017","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.3201\/eid2509.190587","article-title":"Blastomycosis misdiagnosed as tuberculosis, India","volume":"25","author":"Kumar","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2021121011285680900_CIT0018","first-page":"421","article-title":"Histoplasmosis, coccidioidomycosis and tuberculosis: a comparative pathological study","volume":"25","author":"Straub","year":"1962","journal-title":"Pathol Microbiol (Basel)"},{"key":"2021121011285680900_CIT0019","doi-asserted-by":"crossref","first-page":"918","DOI":"10.4269\/ajtmh.15-0837","article-title":"Clinical and laboratory profile of persons living with human immunodeficiency virus\/acquired immune deficiency syndrome and histoplasmosis from a Colombian hospital","volume":"95","author":"Caceres","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"2021121011285680900_CIT0020","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1590\/0037-8682-0425-2017","article-title":"Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil","volume":"51","author":"Ramos","year":"2018","journal-title":"Rev Soc Bras Med Trop"},{"key":"2021121011285680900_CIT0021","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1128\/CMR.00027-06","article-title":"Histoplasmosis: a clinical and laboratory update","volume":"20","author":"Kauffman","year":"2007","journal-title":"Clin Microbiol Rev"},{"key":"2021121011285680900_CIT0022","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1056\/NEJMoa1500245","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. adults","volume":"373","author":"Jain","year":"2015","journal-title":"N Engl J Med"},{"key":"2021121011285680900_CIT0023","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2021121011285680900_CIT0024","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1164\/rccm.201906-1185ST","article-title":"Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. An Official American Thoracic Society Clinical Practice Guideline","volume":"200","author":"Hage","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2021121011285680900_CIT0025","doi-asserted-by":"crossref","first-page":"16863","DOI":"10.1038\/s41598-018-35340-4","article-title":"Pre-existing symptoms and healthcare utilization prior to diagnosis of neuroendocrine tumors: a SEER-Medicare database study","volume":"8","author":"Shen","year":"2018","journal-title":"Sci Rep"},{"key":"2021121011285680900_CIT0026","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1089\/jwh.2009.1550","article-title":"Identification of ovarian cancer symptoms in health insurance claims data","volume":"19","author":"Devlin","year":"2010","journal-title":"J Womens Health (Larchmt)"},{"key":"2021121011285680900_CIT0027","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.3201\/eid2508.190019","article-title":"Delays in coccidioidomycosis diagnosis and relationship to healthcare utilization, Phoenix, Arizona, USA","volume":"25","author":"Ginn","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2021121011285680900_CIT0028","volume-title":"ICD-10-CM","author":"Centers for Medicare and Medicaid Services (CMS); National Center for Health Statistics (NCHS)"},{"key":"2021121011285680900_CIT0029","first-page":"17","volume-title":"Coding common respiratory problems in ICD-10.","author":"Beckman","year":"2014"},{"key":"2021121011285680900_CIT0030","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1177\/1062860605280358","article-title":"Accuracy of administrative data for identifying patients with pneumonia","volume":"20","author":"Aronsky","year":"2005","journal-title":"Am J Med Qual"},{"key":"2021121011285680900_CIT0031","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/jpids\/pit036","article-title":"How accurate are international classification of diseases-10 diagnosis codes in detecting influenza and pertussis hospitalizations in children?","volume":"3","author":"Moore","year":"2014","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2021121011285680900_CIT0032","doi-asserted-by":"crossref","first-page":"e201323","DOI":"10.1001\/jamanetworkopen.2020.1323","article-title":"Respiratory and nonrespiratory diagnoses associated with influenza in hospitalized adults","volume":"3","author":"Chow","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2021121011285680900_CIT0033","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.3201\/eid2111.141950","article-title":"Mycotic infections acquired outside areas of known endemicity, United States","volume":"21","author":"Benedict","year":"2015","journal-title":"Emerg Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa1554\/34245133\/ciaa1554.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/73\/11\/e4336\/41607907\/ciaa1554.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/73\/11\/e4336\/41607907\/ciaa1554.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T11:38:27Z","timestamp":1639136307000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/11\/e4336\/5923374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":33,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,14]]},"published-print":{"date-parts":[[2021,12,6]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa1554","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,12,1]]},"published":{"date-parts":[[2020,10,14]]}}}