September 2019

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 25, No. 9, September 2019

Important Note: Not all articles that EID publishes represent work done at CDC or by CDC staff. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC in the EID journal”). Opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated. EID requests that, when possible, you include a live link to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Ahead of Print section of the EID website at

The articles of interest summarized below will appear in the September 2019 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until August 21, 2019, at 12 p.m. EDT.

1.      Risk for Clostridiodes difficile Infection among Older Adults with Cancer, Mini Kamboj et al..

Clostridiodes difficile bacteria cause inflammation of the colon, which commonly results in diarrhea. In the United States, C. difficile infection (CDI)  is the leading cause of healthcare-associated infections. Incidence and severity of this infection are highest among older adults. Common factors that influence risk for C. difficile infection are advanced age (26 times more likely to affect older than younger adults), weakened immune system, exposure to healthcare facilities, antibiotics. Because people with cancer also experience all of those factors, the risk for C. difficile infection may be amplified by cancer or its treatment. Complicating matters is the fact that C. difficile infection symptoms are often indistinguishable from the effects of cancer treatment and certain types of chemotherapy pose an additional risk for CDI. Thus, to determine whether the risk for C. difficile infection is higher among older adults with cancer, researchers compared data for Medicare beneficiaries with and without cancer in 2011. They found that odds of  being diagnosed with C. difficile infection were indeed higher among patients with than without cancer, especially those who had liquid tumors (i.e., blood cancers) and those with recently diagnosed solid tumors (e.g., breast, colon, lung, prostate, and head and neck cancers) that had metastasized to other locations in the body. Knowing who is at highest risk can help healthcare providers make timely diagnosis and apply preventive measures in the most susceptible patients.

Contact: Mini Kamboj, 1275 York Ave, New York, NY 10065, USA; email:

2.    Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA, Rachel Ginn et al.

Coccidioidomycosis (also known as Valley fever) is an infection caused by the soil-dwelling fungi Coccidioides immitis or Coccidioides posadasii. In areas where coccidioidomycosis is endemic (parts of Arizona, California, Utah, New Mexico, Texas, Mexico, and elsewhere in Central and South America), the disease is responsible for about one quarter of all community-acquired pneumonia cases (CAP). Although accurate diagnosis requires specific laboratory tests, one study conducted in the coccidioidomycosis-endemic region of Phoenix, Arizona, found that such testing was ordered for no more than 13% of CAP patients. Concerned that delays in accurate diagnosis might be extensive, researchers in Phoenix conducted a retrospective analysis of electronic medical records from the period 2011–2014. They aimed to estimate diagnostic delays and healthcare use before and after a coccidioidomycosis diagnosis was confirmed and to assess how those diagnostic delays affected the overall healthcare charges incurred by patients. They found that nearly half (46%) of CAP patients experienced delays in diagnosis of more than 1 month and, as expected, healthcare charges billed before diagnosis increased with length of delay. If the analytic method that these researchers developed is validated and perhaps improved in future studies, it could allow for automated monitoring of diagnostic delays as a metric of healthcare quality assessment, without needing expert review of medical records.

Contact: David Mogollon, University of Arizona, Tucson, AZ 85724, USA; email:


Page last reviewed: August 22, 2019