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 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.

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.

[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.

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.

Histoplasmosis in Veterans Administration hospitals in middle America.

A series of clinical studies of histoplasmosis based on demonstrations of etiology led to descriptions of chronic pulmonary histoplasmosis, the principal type in adults, and amphotericin B as an effective therapy. A participant recreates the atmosphere of discovery during the contributions of a team comprising a mycologist, a surgeon and two physicians using cultures of excised lung and sputum to clearly identify cases of chronic pulmonary histoplasmosis. Subsequently cooperating physicians in several V.A. Hospitals carried out randomized studies of treatment, dosage, and side effects that established Amphotericin B as the sole curative therapy for chronic pulmonary histoplasmosis for 20 years.

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.