Histoplasma Fungal Spread

National problem: serious lung infections caused by soil fungi

Fungal histoplasm spread

The Histoplasma fungus, which causes lung infections, was concentrated in the Midwest in the 1950s and 1960s (top map), but now causes significant disease across much of the country (bottom). Researchers at Washington University School of Medicine in St. Louis have found that the three main types of soil fungi that cause lung infections have all expanded their ranges in recent decades. Using outdated maps could result in delayed or missed diagnoses. Credit: Patrick Mazi and Andrej Spec/University of Washington

Outdated maps of pathogenic fungi can lead to delayed and missed diagnoses.

Soil fungi cause significant numbers of serious lung infections in 48 of 50 states and the District of Columbia, including many areas long thought to be free of deadly environmental fungi. That’s according to a recent study by researchers at Washington University School of Medicine in St. Louis.

Studies from the 1950s and 1960s indicated that fungal lung infections were only a problem in certain parts of the country. This is no longer the case, shows a new study, published on November 11 in the journal Clinical infectious diseases. Doctors who rely on outdated maps of pathogenic fungi may miss signs of a fungal lung infection, leading to delayed or incorrect diagnoses, the researchers said.

“Fungal infections are much more common than people realize, and they do spread.” — Andrej Spec, MD

“Every few weeks I get a call from a Boston-area doctor — a different doctor each time — about a case they can’t solve,” said lead author Andrej Spec. , MD, associate professor of medicine and specialist in fungal diseases. infections. “They always start by saying, ‘We don’t have any history here, but it sure looks like history.’ I say, ‘You call me about it all the time. do have a history. “

Histoplasmor histo, is one of the top three species of soil fungi that cause lung infections in the United States. Historically, Histoplasm has been found in the Midwest and parts of the East, Coccidioides in the southwest, and Blastomyces in the Midwest and the South. But a growing number of case reports and anecdotes suggest that all three have expanded outside their traditional ranges in recent decades, possibly due to climate change.

Fungal spread United States

The three main species of fungi that cause lung infections in the United States — Histoplasma (red), Blastomyces (blue), and Coccidioides (green) — have all expanded their ranges in recent decades. These maps were created using data from 1955 (top row) and 2007-2016 (bottom row). Using outdated maps can lead to delayed or missed diagnoses. Credit: Patrick Mazi and Andrej Spec/University of Washington

People develop fungal lung infections after breathing in fungal spores in soil. The spores become airborne when soil is disturbed by agriculture, landscaping, construction, or even just by people walking through fungus-rich environments such as caves. Most healthy adults and children can fight off a fungal infection easily, but infants, the elderly, and people with weakened immune systems may develop fever, cough, fatigue, and other symptoms. Fungal lung infections can easily be confused with bacterial or viral lung infections such as

First identified in 2019 in Wuhan, China, as COVID-19, or coronavirus disease 2019, (originally called "2019 novel coronavirus" or 2019-nCoV) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It spread globally, leading to the 2019-22 coronavirus pandemic.

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Histoplasmosis is an infection caused by a fungus called Histoplasma. The fungus lives in the environment, especially in soil that contains large amounts of bird or bat droppings. People can get histoplasmosis after breathing in the microscopic fungal spores from the air. Although most people who breathe in the spores don’t get sick, those who do may have a fever, cough, and fatigue. Many people who get histoplasmosis will get better on their own without medication, but in some people, such as those who have compromised immune systems, the infection can become severe.

“People with fungal lung infection often spend weeks trying to get the right diagnosis and appropriate treatment, and the whole time they’re feeling terrible,” said lead author Patrick B. Mazi, MD, a clinical fellow in infectious diseases. “They usually have multiple healthcare visits with multiple opportunities for testing and diagnosis, but the doctor just doesn’t consider a fungal infection until they’ve exhausted all other possibilities.”

Spec, Mazi, and colleagues set out to determine where soil fungi are sickening people today. The Centers for Disease Control and Prevention (CDC) last revised its maps of disease-causing fungi in 1969.

The researchers calculated the number of fungal lung infections nationwide from 2007 to 2016 using Medicare fee-for-service claims from all 50 states and the District of Columbia. Using the patients’ home addresses to identify counties of residence, they calculated the number of cases per 100,000 person-years for each county. (Person-years are a way to correct for the fact that counties can have wildly different population sizes; one person on Medicare for one year is one person-year). Counties with more than 100 cases caused by Histoplasma or Coccidioides, or 50 cases caused by Blastomyces, per 100,000 person-years were defined as having a meaningful number of fungal lung infections.

Of the 3,143 counties in the U.S., 1,806 had meaningful numbers of lung infections caused by Histoplasma, 339 of Coccidioides and 547 of Blastomyces. These counties were distributed across the majority of the U.S. Across the 50 states plus DC, 94% had at least one county with a problem with Histoplasma lung infections, 69% with Coccidioides and 78% with Blastomyces.

“Fungal infections are much more common than people realize, and they’re spreading,” Spec said. “The scientific community has underinvested in studying and developing treatments for fungal infections. I think that’s beginning to change, but slowly. It’s important for the medical community to realize these fungi are essentially everywhere these days and that we need to take them seriously and include them in considering diagnoses.”

Reference: “The Geographic Distribution of Dimorphic Mycoses in the United States for the Modern Era” by Patrick B Mazi, MD, John M Sahrmann, MA, Margaret A Olsen, PhD, Ariella Coler-Reilly, BA, Adriana M Rauseo, MD, Matthew Pullen, MD, Julio C Zuniga-Moya, MD, William G Powderly, MD and Andrej Spec, MD, 11 November 2022, Clinical Infectious Diseases.
DOI: 10.1093/cid/ciac882

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