{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:04:58Z","timestamp":1791939898665,"version":"4.3.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T00:00:00Z","timestamp":1610064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Coccidioides fungi are found primarily in the southwestern United States and are the cause of coccidioidomycosis. Tumor necrosis factor \u03b1 inhibitors (TNFIs) are therapies for autoimmune and inflammatory conditions; their association with coccidioidomycosis is not well characterized. We aimed to determine the prevalence and characteristics of coccidioidomycosis among TNFI recipients with different inflammatory disorders at a tertiary care center. We retrospectively reviewed the electronic health records of patients at our institution from April 4, 2010 to December 17, 2017, who received TNFIs (infliximab, etanercept, adalimumab, certolizumab pegol, or golimumab) and had positive culture, pathologic, and\/or serologic results for coccidioidomycosis. Among 1770 patients identified who received TNFIs, 49 (2.8%) had proven or probable coccidioidomycosis. Of these 49, 28 (57%) were men, 47 (96%) were White, and 42 (86%) had pulmonary coccidioidomycosis. The most common TNFIs used were adalimumab, infliximab, and etanercept. Coccidioidomycosis was identified in 25 of 794 patients with rheumatologic disorders (3.1%), 18 of 783 patients with inflammatory bowel disease (IBD) (2.3%), and six of 193 patients with dermatologic disorders (3.1%) (P\u00a0=\u00a0.34). There was no difference in coccidioidal infections among recipients of any particular TNFI agents. A minority of patients (7\/49, 14%) had an extrapulmonary infection, and the majority of these (6\/7) had IBD. Our study shows a low prevalence of coccidioidomycosis in TNFI recipients, even within the Coccidioides-endemic area. Persons with IBD were disproportionately represented among those with extrapulmonary coccidioidomycosis. Treatment with azoles was effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay Summary<\/jats:title>\n                    <jats:p>Among 1770 patients who received tumor necrosis factor \u03b1 inhibitors, 49 (2.8%) had newly acquired coccidioidomycosis over a 7-year period. Dissemination occurred in 14.3%, but disproportionately among those with underlying inflammatory bowel disease. All patients recovered with medical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/mmy\/myaa109","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T16:47:29Z","timestamp":1609865249000},"page":"720-727","source":"Crossref","is-referenced-by-count":6,"title":["Coccidioidomycosis in patients with various inflammatory disorders treated with tumor necrosis factor \u03b1 inhibitors"],"prefix":"10.1093","volume":"59","author":[{"given":"Nathan L","family":"Delafield","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhubene","family":"Mesbah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Curtis R","family":"Lacy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renni R","family":"Panicker","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabana F","family":"Pasha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lester E","family":"Mertz","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A","family":"Yiannias","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis E","family":"Blair","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,8]]},"reference":[{"key":"2021070523530682000_bib1","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1055\/s-0035-1562900","article-title":"Coccidioidomycosis: recent updates","volume":"36","author":"Twarog","year":"2015","journal-title":"Semin Respir Crit Care Med"},{"key":"2021070523530682000_bib2","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3201\/eid1563.081007","article-title":"Coccidioidal pneumonia, Phoenix, Arizona, USA, 2000\u20132004","volume":"15","author":"Kim","year":"2009","journal-title":"Emerg Infect 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