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Endemic fungal infections high among older US adults in Midwest, West
Baddley JW. Emerg Infect Dis.2011; doi:http://dx.doi.org/10.3201/eid1709.101987.
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The rates for histoplasmosis, coccidioidomycosis and blastomycosis are high in the Midwest and West regions of the United States and were more frequent among older adults enrolled in Medicare, according to new findings published in Emerging Infectious Diseases.
“These endemic mycoses were geographically distributed, but not all occurred in a traditionally mycosis-endemic area,” John W. Baddley, MD, MSPH, of the division of infectious diseases at the University of Alabama at Birmingham, and colleagues wrote in the study.
Histoplasmosis was most common, although the highest state-based incidence rates were seen for coccidioidomycosis, according to the researchers. “As older persons in the US continue to travel and participate in outdoor activities, exposure to these pathogens may increase. Moreover, increasing age and decreasing cell-mediated immunity as a result of transplantation, chemotherapy, or other immunosuppressive medications increase the risk for endemic mycoses.”
National Medicare data were pooled between 1999 and 2008. The researchers examined the epidemiologic and geographic distribution of endemic mycoses in older adults and assessed national, regional and state-based incidence rates. Mortality rates were assessed 90 days after diagnosis.
Of the 776 cases of mycoses identified, 357 were histoplasmosis, 345 were coccidioidomycosis and 74 were blastomycosis; 11.1% of cases were not exposed to traditional mycosis-endemic areas.
Midwestern states had the highest incidence of histoplasmosis (6.1/100,000 person-years) and blastomycosis (1/100,000 person-years). Specifically, Indiana (13/100,000 person-years) and Arkansas (12/100,000 person-years) had the highest incidence of histoplasmosis; Mississippi (6.4/100,000 person-years) and Wisconsin (5.7/100,000 person-years) had the highest incidence of blastomycosis.
Coccidioidomycosis incidence was highest in Western US states (15.2/100,000 person-years), particularly in Arizona (90.5/100,000 person-years) and California (10.1/100,000 person-years).
“Our best guess is that some of these patients had lived in endemic areas long ago and were exposed to the germ. Years later, the infection occurred and was diagnosed in an area that does not typically have cases,” Baddley told Infectious Disease News. “In our study, we did not have information on place of residence for the patient’s complete life, only for the previous 2 to 8 years. An alternate explanation is that there has been a geographic spread of some of these organisms, but this is less likely.” – by Ashley DeNyse
Disclosure:This study was supported by the Agency for Healthcare Research and Quality; ClinicalTrials.gov number, R01HS018517.