Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990-2015.

Endemic mycoses represent a growing public health challenge in North America. We describe the epidemiology of 1,392 microbiology laboratory-confirmed cases of blastomycosis, histoplasmosis, and coccidioidomycosis in Ontario during 1990-2015. Blastomycosis was the most common infection (1,092 cases; incidence of 0.41 cases/100,000 population), followed by histoplasmosis (211 cases) and coccidioidomycosis (89 cases). Incidence of blastomycosis increased from 1995 to 2001 and has remained elevated, especially in the northwest region, incorporating several localized hotspots where disease incidence (10.9 cases/100,000 population) is 12.6 times greater than in any other region of the province. This retrospective study substantially increases the number of known endemic fungal infections reported in Canada, confirms Ontario as an important region of endemicity for blastomycosis and histoplasmosis, and provides an epidemiologic baseline for future disease surveillance. Clinicians should include blastomycosis and histoplasmosis in the differential diagnosis of antibiotic-refractory pneumonia in patients traveling to or residing in Ontario.

Multistate Epidemiology of Histoplasmosis, United States, 2011-2014

Histoplasmosis is one of the most common mycoses endemic to the United States, but it was reportable in only 10 states during 2016, when a national case definition was approved. To better characterize the epidemiologic features of histoplasmosis, we analyzed deidentified surveillance data for 2011-2014 from the following 12 states: Alabama, Arkansas, Delaware, Illinois, Indiana, Kentucky, Michigan, Minnesota, Mississippi, Nebraska, Pennsylvania, and Wisconsin. We examined epidemiologic and laboratory features and calculated state-specific annual and county-specific mean annual incidence rates. A total of 3,409 cases were reported. Median patient age was 49 (interquartile range 33-61) years, 2,079 (61%) patients were male, 1,273 (57%) patients were hospitalized, and 76 (7%) patients died. Incidence rates varied markedly between and within states. The high hospitalization rate suggests that histoplasmosis surveillance underestimates the true number of cases. Improved surveillance standardization and surveillance by additional states would provide more comprehensive knowledge of histoplasmosis in the United States.

Epidemiology of Histoplasmosis Outbreaks, United States, 1938-2013.

Histoplasmosis has been described as the most common endemic mycosis in the United States. However, histoplasmosis is not nationally notifiable. Its presumed geographic distribution is largely derived from skin test surveys performed during the 1940s, and information about its local features comes primarily from outbreak investigations. We conducted a literature review to assess epidemiologic features of histoplasmosis outbreaks in the United States. During 1938-2013, a total of 105 outbreaks involving 2,850 cases were reported in 26 states and the territory of Puerto Rico. Common exposure settings were chicken coops and buildings or other structures undergoing renovation or demolition. Birds, bats, or their droppings were reported to be present in 77% of outbreak settings, and workplace exposures were reported in 41% of outbreaks. The continued occurrence of histoplasmosis outbreaks, particularly work-related ones involving known disturbance of bird or bat droppings, highlights the need to increase awareness of the disease.

Una actualización acerca de histoplasmosis / Histoplasmosis updating

La histoplasmosis infección causada por el hongo Histoplasma capsulatum ha sido reportada en todos los continentes y se considera endémica en el continente americano, incluida Cuba. El hongo se desarrolla en el suelo con excretas de aves y murciélagos, donde es capaz de producir abundantes microconidios, que al ser inhalados por el hombre son capaces de causar la infección. El cuadro clínico puede variar, desde infecciones asintomáticas hasta cuadros diseminados graves que involucran a uno o varios órganos y sistemas y que afectan sobre todo a pacientes con sida, neoplasias hematológicas, con trasplantes u otras inmunodeficiencias. Los principales grupos de riesgo incluyen además, aquellos individuos que por razones ocupacionales se expongan los aerosoles contaminados con el hongo. El diagnóstico de laboratorio se basa en la observación de este en fluidos y tejidos orgánicos, en el cultivo de esos materiales y en la detección de anticuerpos y antígenos específicos. Los métodos moleculares, en especial mediante la reacción en cadena de la polimerasa, aunque no han sido suficientemente evaluados, pudieran representar un importante avance en el diagnóstico temprano de esta micosis. Para el tratamiento de las formas agudas moderadas, localizadas y respiratoria crónica se recomienda el itraconazol, mientras que para las formas graves y diseminadas la droga de elección es la anfotericina B, con preferencia en alguna de sus formulaciones lipídicas. La histoplasmosis representa hoy una de las micosis sistémicas más importante en las Américas, con una amplia distribución en todas las regiones de Cuba(AU)

Histoplasmosis, an infection caused by the fungus Histoplasma capsulatum, has been reported all over the world and is considered endemic in the American continent, including Cuba. This fungus grows on the soils contaminated with bird and bat excreta, where it produces a great number of microconidia that could cause the infection when they are inhaled. The clinical spectrum varies from asymptomatic infections to serious disseminated diseases involving one or many organ systems and affects mainly AIDS patients, patients with hematological neoplasias, transplant recipients or other immunosuppressed patients. The main risk groups include those individuals whose working activities make them be exposed to aerosols contaminated with H. capsulatum. Lab diagnosis is based on the microscopic observation, isolation and identification of the fungus in fluid or tissue samples of patients, and on specific antigen and antibodies detection. The molecular methods based on polymerase chain reaction have not been sufficiently defined, and they could be an important advance in the early diagnosis of this mycosis. Itraconazole is recommended for treatment of moderate, localized and chronic infection whereas amphotericin B is the drug of choice for disseminated and serious manifestations, particularly in its lipidic formulations. At present, histoplasmosis is considered one of the most important systemic mycoses in the Americas, and it is widely spread over all regions of Cuba(AU)

[Histoplasmosis story from Tennessee, U.S.A. to Turkey]. / Tennessee (ABD)'den Türkiye'ye histoplazmozun öyküsü.

Histoplasmosis is a mycotic disease that is acquired by inhalation of spores of the dimorphic fungus Histoplasma capsulatum. It is an acute, subacute or chronic, localized or systemic, sporadic, granulomatous infectious disease caused by yeast form of the fungus, and can present just like pulmonary tuberculosis. Originally thought to be a rare tropical disease, histoplasmosis has been recorded from the whole America continent mainly the central zone of the United States, whole continents except Antarctica and more than 60 countries. In this article the discovery and identification story of H. capsulatum and histoplasmosis in United States especially by the researchers in Vanderbilt University Hospital (VUMC) in Nashville-Tennessee, was reminded. The first antemortem diagnosis of histoplasmosis was made at VUMC in 1932 by MDs Edna Tomkins and Katherine Dodd, who found the organism in peripheral blood monocytes of an infant. The man who succeeded in growing and defining the H. copsulatum for the first time in the world is Dr William A. DeMonbreun. VUMC has been closely associated with progress in the understanding of the disease ever since. Ekrem Kadri Unat was the researcher who initiated the pivotal systemic mycological studies for histoplasmosis in Turkey. First human histoplasmosis case was reported by Tevfik Saglam, MD in 1945 and first feline case was reported by DVM Resat S. Akün in 1949. This feline case was the first histoplasmosis case defined in a cat not only in Turkey but also in the world. Ayhan Yücel MD and Kantarcloglu isolated H. capsulatum from environmental samples in 1989 for the first time in Turkey. Owing to these data, it is believed that Turkey is a possible endemic region for this fungal disease. Therefore it is aimed to make a concise review of histoplasmosis in U.S.A., Europe and Turkey in this article.

Dr William DeMonbreun: description of his contributions to our understanding of histoplasmosis and analysis of the significance of his work.

Histoplasmosis was proven to be a fungal infection 70 years ago by Dr William DeMonbreun, at the time an assistant professor in the Department of Pathology at Vanderbilt Medical School. The significance of his work is analyzed in relationship to the evolution of knowledge about this important fungal infection. His discovery was also central to establishing the legitimacy of the recently reorganized medical school. Vanderbilt Medical School in 1925 was an experiment in building an educational institution essentially from scratch-the outcome of the experiment could be judged in the near term only by research productivity and Dr DeMonbreun's work was one of the 5 major discoveries made at Vanderbilt in the first decade of its existence. Further, his work is the bedrock on which Christie and Peterson later showed that histoplasmosis was endemic in the Ohio River Valley. Their studies plus a host of case reports and reviews up to recent times have contributed significantly to the academic standing of Vanderbilt. Heretofore unpublished illustrations and details about the prototypic cases are included for historical purposes. New light is also shed on the chain of circumstances that led to Vanderbilt's role in the evolution of knowledge about histoplasmosis. Finally, information is provided about Dr DeMonbreun's career after his discovery.

Histoplasmosis en México, aspectos históricos y epidemiológicos / Histoplasmosis in Mexico, historic and epidemiological aspects

Introducción: La histoplasmosis es una enfermedad pulmonar considerada como ocupacional. Su agente etiológico. Histoplasma capsulatum, es un hongo dimórfico distribuido en sitios donde existen cantidades importantes de excretas de murciélagos y aves. Los brotes epidémicos son frecuentemente originados por las visitas hacia los ambientes cerrados por alguna actividad laboral o recreativa. Este estudio informa sobre la distribución de la histoplasmosis en México. Se conformó con las publicaciones que se han hecho hasta la fecha, muchas de las cuales presentan datos poco sistematizados sobre la enfermedad en el país, obtenidos con diferentes metodologías y en diversas circunstancias. Aspectos históricos y estado actual de la histoplasmosis en México: Se contemplan aspectos históricos fundamentales, así como los epidemiológicos, que permiten conjuntar un marco del conocimiento acutal de la histoplasmosis en el país. Se rescatan datos que indican que la histoplasmosis en México data desde 1895 y se presentan información reciente que sugiere que la enfermedad está ampliamente distribuida en la mayoría de los estados de la República, predominando en los estados del sur y centro, generalmente ocasionada por brotes importantes, con mayor frecuencia en individuos mayores de 15 años. La importancia de este estudio es el advertir a las autoridades de salud sobre la actual prevalencia y distribución de la enfermedad en el país y proponer mecanismos para su reincorporación al Sistema Nacional de Vigilancia Epidemiológica así como criterios para la asignación de su endemicidad en el país

Biological and sociocultural approaches of histoplasmosis in the State of Guerrero, Mexico.

Histoplasmosis is a deep mycosis with a high prevalence in America. Its aetiological agent, Histoplasma capsulatum, is found in Mexico, mainly in confined spaces, where it grows on bat guano or bird droppings. A research project has been developed in the State of Guerrero, Mexico, where many contaminated caves and mines are visited by individuals and epidemic outbreaks have been recorded. Data concerning human skin test response to histoplasmin antigen, host genetic predisposition to Histoplasma infection, sociocultural, socioeconomical and ethnobiological aspects of the disease in Guerrero are summarized in this paper.

El espectro clínico-epidemiológico de la histoplasmosis pulmonar: Avances recientes y perspectivas futuras / The clinical-epidemilogical spectrum of pulmonary histoplasmosis. recent advances and future perspectives

La histoplasmosis es una micosis endémica en todos los continentes excepto en la Antártida, causado por el hongo dimórfico Histoplasma capsulatum, var. capsulatum. La infección pulmonar primaria generalmente es asintomática, o una enfermedad febril, autolimitada. Se han reconocido tres categorías diferentes: pulmonar aguda, pulmonar crónica y diseminada progresiva, con ataque al sistema fagocítrico. Las pruebas serológicas, los cultivos del hongo y la histopatología son útiles para establecer el diagnóstico. Los tejidos deben ser teñidos con plata para visualizar las levaduras. El sistema del hemocultivo de lisiscentrifugación, puede detectar al H. capsulatum de una a dos semanas. Existe un procedimiento para la detección del antígeno, muy útil para el seguimiento de la terapia, incluyendo a los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). La terapia antifúngica no está indicada en la mayoría de los enfermos, aunque algunos tienen una enfermedad prolongada (> 3 semanas). El diagnóstico temprano y un tratamiento oportuno con enfotericina B o itraconazol, puede acelerar la resolución de la enfermedad. El flunconazol es una elección razonable en la terapia supresiva crónica

Epidemiologic classics.

Epidemiology is the study of the relationships of the various factors determining the frequency and distribution of disease in a human community; the field of medicine concerned with the determination of the specific causes of localized outbreaks such as hepatitis,..., or any other disease of recognized etiology.