Re-drawing the Maps for Endemic Mycoses

Abstract

Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.

Occupational Histoplasmosis: Epidemiology and Prevention Measures

“…Large-scale skin-testing studies performed in the 1940s and 50s not only provided the basis for the organism’s approximate geographic distribution, but also confirmed widespread asymptomatic infection with Histoplasma based on the high prevalence of positive reactions to Histoplasma antigen in certain areas [ 12 , 19 , 20 ]. Based on public health surveillance, environmental data, and outbreak investigations, the geographic distribution of histoplasmosis is likely wider than currently recognized [ 10 , 21 ]. Similarly, estimates of case counts and incidence are likely subject to underreporting and misdiagnosis [ 22 ].…”

“…Histoplasma has a nearly worldwide distribution but is most common in North America and Central America [ 10 ]. In the United States, Histoplasma mainly lives in the central and eastern states, particularly areas around the Ohio and Mississippi River Valleys.…”

“…H. capsulatum var. capsulatum has a nearly worldwide distribution but appears to be most common in the central and eastern United States, particularly around the Ohio and Mississippi River Valleys [ 10 ]. People in these areas are at risk for inhaling Histoplasma from the environment, especially those who have occupations or participate in activities exposing them to soil that contains bird or bat droppings [ 11 ].…”

Native vs Prosthetic Valve Histoplasma capsulatum Infective Endocarditis: A Case Report and Systemic Literature Review Comparing Patient Presentation, Treatment Modalities, Clinical Outcomes, and Diagnostic Laboratory Testing

“…Geographically, it occurs throughout the world. In Canada, it is primarily seen in Quebec and Ontario along the St. Lawrence Seaway and the Great Lakes Drainage Basin [ 1 ]. It is seen in the entire Eastern half of the United States, with a hyperendemic focus along the Ohio and Mississippi River Valleys [ 1 ].…”

“…In Canada, it is primarily seen in Quebec and Ontario along the St. Lawrence Seaway and the Great Lakes Drainage Basin [ 1 ]. It is seen in the entire Eastern half of the United States, with a hyperendemic focus along the Ohio and Mississippi River Valleys [ 1 ]. It is also seen throughout most of Central and South America and the Southern half of Africa.…”