Histoplasmosis in the United States – new insights and myth busting

A new study carried out by the Mycotic Diseases Branch at the Centers for Disease Control and Prevention in Atlanta, Georgia, US is dispelling some of the common myths around histoplasmosis in the US. Previous research has theorised that histoplasmosis is the most common endemic mycosis in the United States and that its distribution is centred in the Ohio and Mississippi River Valleys. A link has been drawn between this fungal disease and bird or bat droppings.

Advances in mycology have allowed the development of more sophisticated laboratory tests, enabling quicker identification of new and emerging pathogens and more sophisticated methods of communicating and sharing this knowledge. This has led the authors of this study to call for a review of histoplasmosis to fill gaps in our knowledge and challenge conventional thinking about the prevalence and origins of this complex fungal infection.

Previous studies have linked histoplasmosis to river valleys in Ohio and Mississippi, but public health data show that there have also been significant outbreaks in Minnesota, Wisconsin, and Michigan. Climate change and shifting land use is opening up other parts of North America to histoplasmosis.

Fig 1 – Estimated areas with histoplasmosis in the United States. CDC’s current estimate of where the fungus that causes histoplasmosis lives in the environment in the United States. Darker shading shows areas where Histoplasma is more likely to live. Diagonal shading shows the potential range of Histoplasma.

Historically histoplasmosis has been linked to contact with bird or bat dropping, but the authors question this approach and urge clinicians to consider a histoplasmosis diagnosis even when the patient has not been in close proximity to these materials.

The study also highlights the need for more information on the epidemiology of disease to reflect the complex presentations of histoplasmosis. More research also needs to be carried out into community acquired pneumonia, lung nodules and ocular histoplasmosis to provide better diagnosis and treatments for those with these conditions.

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Histoplasmosis in the United States – new insights and myth busting
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