A meta-analysis by Pourbaix et al found a overall risk ratio of 1.41 when comparing risk of IFI in smokers to non-smokers, particularly for infections caused by dimorphic fungi such as histoplasmosis, blastomycosis and coccidioidomycosis
Suspect histoplasmosis in returning travellers from an endemic area presenting with fever and cough
Histoplasmosis can present in a variety of ways, making it difficult to diagnose. Dr Staffolani and colleagues carried out a systematic review of 835 cases of histoplasmosis (including 45 clusters) from the literature, among immunocompetent patients who had recently returned from an endemic area. Manifestations included fever (91%), cough (55%), constitutional symptoms (58%), headache (52%) and chest pain (41%).