Geographic Distribution of Dimorphic Mycoses Expanding in US

Considering all U.S. states and Washington D.C., 94, 69, and 78 percent had at least one county above the clinically relevant threshold for histoplasmosis, coccidioidomycosis, and blastomycosis, respectively.

HealthDay News — The geographic distribution of dimorphic mycoses (DM) is expanding in the United States, according to a study published online Nov. 11 in Clinical Infectious Diseases and an editorial published online Nov. 22 in the Annals of Internal Medicine.

Patrick B. Mazi, M.D., from the Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective analysis of >45 million Medicare fee-for-service beneficiaries from Jan. 1, 2007, through Dec. 31, 2016, to update the geographic distributions of DM in the United States. For each U.S. county, the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis was examined. The clinically meaningful thresholds for incidence were defined as 100, 100, and 50 cases per 100,000 person-years for histoplasmosis, coccidioidomycosis, and blastomycosis, respectively.

The researchers identified 79,749 histoplasmosis, 37,726 coccidioidomycosis, and 6,109 blastomycosis diagnoses in unique persons across 3,143 U.S. counties from 2007 to 2013. Considering all U.S. states and Washington D.C., 94, 69, and 78 percent had at least one county above the clinically relevant threshold for histoplasmosis, coccidioidomycosis, and blastomycosis, respectively.

“Although these infections are increasing in geographic reach and frequency, current guidelines on community-acquired pneumonia from the American Thoracic Society and the Infectious Diseases Society of America do not offer specific testing or treatment recommendations,” George R. Thompson III, M.D., from the University of California-Davis Medical Center in Sacramento, and Tom M. Chiller, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, write in a related editorial. “In regions that are hyperendemic for endemic mycoses, the diagnosis and testing should be considered in all patients with suggestive illness.”

Several authors disclosed financial ties to pharmaceutical companies, including Mayne Pharma and Astellas, which partially funded the study.

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