Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America.

Coccidioidomycosis (Valley fever) has been a known health threat in the United States (US) since the 1930s, though not all states are currently required to report disease cases. Texas, one of the non-reporting states, is an example of where both historical and contemporary scientific evidence define the region as endemic, but we don't know disease incidence in the state. Mandating coccidioidomycosis as a reportable disease across more US states would increase disease awareness, improve clinical outcomes, and help antifungal drug and vaccine development. It would also increase our understanding of where the disease is endemic and the relationships between environmental conditions and disease cases. This is true for other nations in North and South America that are also likely endemic for coccidioidomycosis, especially Mexico. This commentary advocates for US state and territory epidemiologists to define coccidioidomycosis as a reportable disease and encourages disease surveillance in other endemic regions across North and South America in order to protect human health and reduce disease burden.

Aerosol Generation During Nasal Airway Instrumentation.

OBJECTIVE: Airborne aerosol transmission, an established mechanism of SARS-CoV-2 spread, has been successfully mitigated in the health care setting through the adoption of universal masking. Upper airway endoscopy, however, requires direct access to the face, thereby potentially exposing the clinic environment to infectious particles. This study quantifies aerosol production during rigid nasal endoscopy (RNE) and RNE with debridement (RNED) as compared with intubation, a posited gold standard aerosol-generating procedure. STUDY DESIGN: Prospective cross-sectional study. SETTING: Subspecialty single-center clinic and surgical study. METHOD: Three aerosol detectors (NANOSCAN-3910, OPS-3330, and APS-3321) with a particle size sensitivity of 10 to 20,000 nm were utilized to detect particulate production during the clinical care of 209 patients undergoing RNE/RNED and 25 patients undergoing intubation. RESULTS: RNE and RNED produced statistically significant particles over baseline in 29.3% and 51.0% of subjects (P = .003-.049 and .002-.047, respectively). Intubation produced statistically significant particles in 31.2% (P = .001-.015). The mean ± SD particle diameter in all tests was 69.9 ± 10.5 nm with 99.7% <300 nm. There were no statistical differences in particle production among RNE, RNED, and intubation. The presence of concomitant cough, sneeze, or prolonged speech similarly did not significantly affect particle production during any procedure. CONCLUSIONS: Instrumentation of nasal airway produces airborne aerosols to a similar degree of those seen during intubation, independent of reactive patient behaviors such as cough or sneeze. These data suggest that an improved understanding is necessary of both the definition of an aerosol-generating procedure and the functional consequences of procedural aerosol generation in clinical settings.

Dust Storms, Valley Fever, and Public Awareness.

We discuss several issues raised by Comrie (2021, https://doi.org/10.1029/2021GH000504), which uses a crowdsourced data set to study dust storms and coccidioidomycosis (Valley fever). There is inconsistency in the term "dust storm" used by science communities. The dust data from National Oceanic and Atmospheric Administration Storm Events Database are from diverse sources, unsuitable for assessing dust-coccidioidomycosis relationships. Population exposure to dust or Coccidioides needs to consider the frequency, magnitude, and duration of dust events. Given abundant evidence that dust storms are a viable driver to transport pathogens, it is in best public interest to advocate dust storms may put people at risk for contracting Valley fever.

Investigating the culturable atmospheric fungal and bacterial microbiome in West Texas: implication of dust storms and origins of the air parcels.

Individuals often experience ailments such as allergies, asthma and respiratory tract infections throughout the year. Weather reports often include estimations of common allergens that can affect these individuals. To describe the local 'atmospheric microbiome' in Lubbock, Texas, USA, we examined the culturable fungal and bacterial microbiome present in the air on calm and dust storm days using internal transcribed spacer (ITS)-1 and 16S rRNA amplicon sequencing, respectively. While some types of airborne fungi were frequently present throughout the year, distinct differences were also observed between calm and dust storm days. We also observed the influence of the origin of air parcels and wind elevation of the air trajectory. The most abundant genera of fungi identified during the study period were Cryptococcus, Aureobasidium, Alternaria, Cladosporium and Filobasidium. This observation was not surprising considering the agricultural intensive environment of West Texas. Interestingly, Cladosporium, a common allergenic mold, was increased during days with dust storm events. The predominant bacterial genera observed were Bacillus, Pseudomonas, Psychrobacter, Massilia and Exiguobacterium. The relative abundance of the psychrophiles, Psychrobacter and Exiguobacterium, was surprising, given the semi-aridity of West Texas. Coupling our observations with back trajectories of the wind (Hybrid Single-Particle Lagrangian Integrated Trajectory models) demonstrated that dust storms, regional anthropogenic activity and origin of air parcels are important influences on the diversity and temporal presence of the atmospheric microbiome.

The effect of dust storm particles on single human lung cancer cells.

Exposure to dust particles during dust storms can lead to respiratory problems, diseases, and even death. The effect of dust particles at the cellular level is poorly understood. In this study, we investigated the impact that dust storm particles (Montmorillonite) have on human lung epithelial cells (A549) at the single cell level. Using live-cell imaging, we continuously followed individual cells after exposure to a wide range of concentrations of dust particles. We monitored the growth trajectory of each cell including number and timing of divisions, interaction with the dust particles, as well as time and mechanism of cell death. We found that individual cells show different cellular fates (survival or death) even in response to the same dust concentration. Cells that died interacted with dust particles for longer times, and engulfed more dust particles, compared with surviving cells. While higher dust concentrations reduced viability in a dose-dependent manner, the effect on cell death was non-monotonic, with intermediate dust concentration leading to a larger fraction of dying cells compared to lower and higher concentrations. This non-monotonic relationship was explained by our findings that high dust concentrations inhibit cell proliferation. Using cellular morphological features, supported by immunoblots and proinflammatory cytokines, we determined that apoptosis is the dominant death mechanism at low dust concentrations, while higher dust concentrations activate necrosis. Similar single cell approaches can serve as a baseline for evaluating other aerosol types that will improve our understanding of the health-related consequences of exposure to dust storms.