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The Geographic Distribution of Dimorphic Mycoses in the United States for the Modern Era.
Mazi, Patrick B; Sahrmann, John M; Olsen, Margaret A; Coler-Reilly, Ariella; Rauseo, Adriana M; Pullen, Matthew; Zuniga-Moya, Julio C; Powderly, William G; Spec, Andrej.
Afiliação
  • Mazi PB; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Sahrmann JM; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Olsen MA; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Coler-Reilly A; Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Rauseo AM; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Pullen M; Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
  • Zuniga-Moya JC; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Powderly WG; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
  • Spec A; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
Clin Infect Dis ; 76(7): 1295-1301, 2023 04 03.
Article em En | MEDLINE | ID: mdl-36366776
ABSTRACT

BACKGROUND:

The dimorphic mycoses (DMs) of the United States-Histoplasma, Coccidioides, and Blastomyces-commonly known as endemic mycoses of North America (in addition to Paracoccidioides) are increasingly being diagnosed outside their historical areas of endemicity. Despite this trend, the maps outlining their geographic distributions have not been updated in more than half a century using a large, nationwide database containing individual-patient-level data.

METHODS:

This was a retrospective analysis of >45 million Medicare fee-for-service beneficiaries from 1 January 2007 through 31 December 2016. Diagnoses of histoplasmosis, coccidioidomycosis, and blastomycosis were defined by International Classification of Diseases, Ninth/10th Revision, codes. The primary outcome was the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis for each US county. Clinically meaningful thresholds for incidence were defined as 100 cases/100 000 person-years for histoplasmosis and coccidioidomycosis and 50 cases/100 000 person-years for blastomycosis.

RESULTS:

There were 79 749 histoplasmosis, 37 726 coccidioidomycosis, and 6109 blastomycosis diagnoses in unique persons from 2007-2016 across 3143 US counties. Considering all US states plus Washington, DC, 94% (48/51) had ≥1 county above the clinically relevant threshold for histoplasmosis, 69% (35/51) for coccidioidomycosis, and 78% (40/51) for blastomycosis.

CONCLUSIONS:

Persons with histoplasmosis, coccidioidomycosis, and blastomycosis are diagnosed in significant numbers outside their historical geographic distributions established >50 years ago. Clinicians should consider DM diagnoses based on compatible clinical syndromes with less emphasis placed on patients' geographic exposure. Increased clinical suspicion leading to a subsequent increase in DM diagnostic testing would likely result in fewer missed diagnoses, fewer diagnostic delays, and improved patient outcomes.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Blastomicose / Coccidioidomicose / Histoplasmose / Micoses Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Blastomicose / Coccidioidomicose / Histoplasmose / Micoses Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos