Blastomycosis Surveillance in 5 States, United States, 1987–2018

Abstract

The median time from symptom onset to diagnosis and the severity of illness suggest that surveillance underestimates the true number of cases.

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

“…Coccidioidomycosis, histoplasmosis, and blastomycosis cases were more common in males, consistent with previous studies (8,14,30), although with substantial differences by pathogen, ranging from 52% of coccidioidomycosis infections to 70% of blastomycosis infections in males. Biologic differences and…”

“…These numbers are substantially lower than those reported in previous studies ( 39 , 40 ), which found that histoplasmosis and blastomycosis result in approximately 5,000 and 1,000 hospitalizations, respectively, each year in the United States according to administrative data, highlighting substantial discrepancies between sources of case reports. Although counts differed considerably, the high hospitalization and mortality rates for histoplasmosis and blastomycosis described in this report align with past surveillance reports ( 8 , 14 , 39 ). In-depth, state-level comparisons of surveillance and administrative hospitalization data are needed to evaluate potential gaps in reporting and accuracy of administrative coding data.…”

“…Histoplasmosis, caused by Histoplasma capsulatum, is acquired primarily in central and eastern states, although the disease likely also occurs to lesser extents across much of the country (Supplementary Figure 2, https:// stacks.cdc.gov/view/cdc/118603). Blastomycosis, caused primarily by Blastomyces dermatitidis and Blastomyces gilchristii, is found in midwestern, south-central, and southeastern states (Supplementary Figure 3, https://stacks.cdc.gov/view/ cdc/118604) (8)(9)(10)(11). The recently described Blastomyces helicus has been found to cause illness in the western United States but remains poorly understood (12).…”

“…Coccidioidomycosis, histoplasmosis, and blastomycosis are frequently misdiagnosed as community-acquired pneumonia or other acute lower respiratory tract infections. Misdiagnoses can lead to inappropriate therapy with antibacterial medications and delayed antifungal treatment ( 8 , 13 , 14 ). Antifungal treatment is recommended based on clinical manifestation and severity of disease ( 2 , 15 , 16 ).…”

“…Previously, each of these diseases has been described separately ( 8 , 30 , 31 ). This report summarizes 2019 U.S. surveillance data on coccidioidomycosis, histoplasmosis, and blastomycosis to examine and compare geographic distribution, populations at risk, and seasonality.…”