Imported endemic mycoses in Spain: Evolution of hospitalized cases, clinical characteristics and correlation with migratory movements, 1997-2014

Abstract

Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements.

Pseudodematiaceous Fungi in Rhinosinusal Biopsies: Report of 2 Cases With Light and Electron Microscopy Analysis

“…Moreover, the increment in immunosuppressed patients and the populations who migrate from tropical or subtropical zones with endemic mycoses also contribute to the increase of individuals who will potentially require a biopsy due to this pathology. 3-8 The foregoing supports the relevant role played by the modern pathology in the diagnosis of many infectious diseases, especially mycoses. The 2 most important questions that the biopsy should resolve in the case of a mycosis are as follows: (1) Is there invasion of the tissue?…”

Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge

“…Incomplete data exist on the incidence and prevalence of this infection in non-endemic countries. In Spain, a prevalence of 0.31 cases (SD 0.1) per 100,000 population-year has been reported, but this may be an underestimation, as only patients seeking for medical advice upon arrival from a presumed endemic region were included (Molina-Morant et al, 2018). Similar studies are lacking in other non-endemic regions.…”

“…Similar studies are lacking in other non-endemic regions. Available figures indicate that histoplasmosis is the most frequent imported mycosis (Salzer et al, 2018): cases correspond to immigrants, expatriates, transient workers or tourists having had Histoplasma exposure in endemic areas (Molina-Morant et al, 2018;Salzer et al, 2018;Staffolani et al, 2018). Transmission related to solid organ donation has been sporadically described (Kamei et al, 2003;Ashbee et al, 2008;Berger, 2018).…”

“…The mortality rate of cases diagnosed in non-endemic areas depends on the clinical form, and the immune status of the host, but also on the diagnostic and therapeutic promptness. For immunocompetent individuals it ranges between 2 and 17.4% (Kamei et al, 2003;Molina-Morant et al, 2018;Salzer et al, 2018). A 10% attributable mortality is reported for histoplasmosis in solid organ transplant recipients (Gajurel et al, 2017).…”

Laboratory Diagnosis of Histoplasmosis: An Update

“…immigrants [11]. It has been estimated that about a half million of people acquire the infection per year and around 100,000 develop a disseminated disease [3].…”