Histoplasmosis more common in rural areas of US
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Key takeaways:
- Studies have shown that the geographic range of histoplasmosis is expanding in the United States.
- The lung infection is more common in rural areas and places with limited health care infrastructure.
Cases of histoplasmosis are more common in rural areas of the United States and places with less health care infrastructure, according to a new study.
People get histoplasmosis by inhaling spores of Histoplasma capsulatum, a fungus that lives in the environment, especially in soil contaminated by bat or bird droppings, according to the CDC. The lung infection can lead to meningitis in severe cases.
Research has shown that the geographic range of H. capsulatum in the U.S. is expanding, possibly because of changes in the climate and human land use, but the authors of the new study noted that it is still most common in central and eastern states.
The researchers who collaborated on the study are from the CDC and state health departments in Arkansas, Illinois, Indiana, Kentucky, Michigan, Minnesota, Pennsylvania and Wisconsin
They extracted county-level data reported by the eight states to the CDC to determine the number of histoplasmosis cases per 100,000 people during 6 years — 2011 to 2014 and 2019 to 2020 — and used the Minority Health Social Vulnerability Index to characterize the cases.
Based on more than 4,800 reported cases of histoplasmosis included in the study, modeling showed that infections were more common in rural counties and areas with limited access to health care, according to the researchers. Other social determinants of health measured by the index — such as socioeconomic status, race and medical vulnerability — “either were not significantly or were inconsistently associated with histoplasmosis incidence,” they reported.
According to the CDC, histoplasmosis is often diagnosed late — or missed altogether. The researchers noted that many vulnerable communities in the U.S. do not have access to the specialists who diagnose most cases of the lung infection: pulmonologists and infectious disease physicians.
Medicare data have shown that nearly 80% of U.S. counties do not have a single ID physician.
In a summary of the study sent to reporters, the CDC said disparities in histoplasmosis could be addressed through “increased awareness of histoplasmosis among health care providers, more accessible diagnostic tests, and investment in rural health services.”
“Considering there are more hospital closures than openings and few urgent care centers,
especially in rural areas, it is critical for primary care providers to consider histoplasmosis in patients who live in or have traveled to histoplasmosis-endemic areas who have compatible signs and symptoms (eg, fever, cough, fatigue, chills, headache, chest pain, body aches) without improvement after empiric antibacterial medications,” the researchers wrote.
References:
- CDC. About histoplasmosis. https://www.cdc.gov/histoplasmosis/about/index.html. Updated April 24, 2024. Accessed Sept. 13, 2024.
- Smith DJ, et al. Emerg Infect Dis. 2024;doi:10.3201/eid3010.231700.
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