Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

Abstract

Problem/Condition: Coccidioidomycosis, histoplasmosis, and blastomycosis are underdiagnosed fungal diseases that often mimic bacterial or viral pneumonia and can cause disseminated disease and death. These diseases are caused by inhalation of fungal spores that have distinct geographic niches in the environment (e.g., soil or dust), and distribution is highly susceptible to climate changes such as expanding arid regions for coccidioidomycosis, the northward expansion of histoplasmosis, and areas like New York reporting cases of blastomycosis previously thought to be nonendemic. The national incidence of coccidioidomycosis, histoplasmosis, and blastomycosis is poorly characterized.Reporting Period: 2019. Description ofSystem: The National Notifiable Diseases Surveillance System (NNDSS) tracks cases of coccidioidomycosis, a nationally notifiable condition reported to CDC by 26 states and the District of Columbia. Neither histoplasmosis nor blastomycosis is a nationally notifiable condition; however, histoplasmosis is voluntarily reported in 13 states and blastomycosis in five states. Health departments classify cases based on the definitions established by the Council of State and Territorial Epidemiologists.

Race and ethnicity: Risk factors for fungal infections?

“…Several epidemiological studies reported higher incidence rates of coccidioidomycosis among racial and ethnic minorities in the US endemic regions [ 136 – 138 ]. This was shown in a recent CDC study using data of reportable endemic mycoses from 26 states that found that American Indian/Alaska Native (AI/AN) cases and Hispanic cases had higher incidence rates of coccidioidomycosis (17.4 and 11.2 per 100,000, respectively) compared to non-Hispanic white cases (4.1 per 100,000).…”

“…This was shown in a recent CDC study using data of reportable endemic mycoses from 26 states that found that American Indian/Alaska Native (AI/AN) cases and Hispanic cases had higher incidence rates of coccidioidomycosis (17.4 and 11.2 per 100,000, respectively) compared to non-Hispanic white cases (4.1 per 100,000). However, data on race and ethnicity were available in less than half (39%) of the reported cases [ 138 ]. In addition, geography and regional exposure to dust might have influenced coccidioidomycosis rates in different racial and ethnic groups.…”

“…The overall incidence of histoplasmosis in these states was 1.8 cases per 100,000 population, including Illinois (292 cases (26%), rate: 2.3 cases per 100,000 persons), Michigan (225 cases (20%), rate 2.3 cases per 100,000 persons), and Minnesota (214 cases (19%), rate 3.8 cases per 100,000 persons). These 3 states accounted for a combined 65% of these cases [ 138 ].…”

“…Of those which hospital data was available for (460 cases), 249 (54%) persons were hospitalized, and 20 (5%) persons died. In this survey, histoplasmosis incidence was similar across racial and ethnic categories (range: 0.9 to 1.3) [ 138 ].…”

“…have been recovered from the environment. A survey of 240 case reports of blastomycosis from 5 states (Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin) in 2019 showed that the overall blastomycosis incidence in these states was 0.8 cases per 100,000 population, with Minnesota (rate 1.4) and Wisconsin (rate 1.7) accounting for 179 (75%) of the total cases [ 138 ]. Endemicity is most pronounced in the hyperendemic regions of north central Wisconsin where the disease incidence can exceed 100 cases per 100,000 inhabitants [ 175 ].…”