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. 2016 Mar;22(3):370-8.
doi: 10.3201/eid2203.151117.

Epidemiology of Histoplasmosis Outbreaks, United States, 1938-2013

Kaitlin Benedict, Rajal K Mody

Epidemiology of Histoplasmosis Outbreaks, United States, 1938-2013

Kaitlin Benedict et al. Emerg Infect Dis. 2016 Mar.

Abstract

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.

Keywords: Histoplasma; United States; bats; birds; disease outbreaks; environment; epidemiology; fungi; histoplasmosis; mycoses.

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Figures

Figure 1
Figure 1
Number of histoplasmosis outbreaks by year of onset and setting, United States, 1938–2013 (N = 105).
Figure 2
Figure 2
Number of outbreak-related cases of histoplasmosis by onset year, United States, 1938–2013 (N = 2,850).
Figure 3
Figure 3
Locations of histoplasmosis outbreaks and number of outbreak-related cases, by state or territory (Puerto Rico, inset), United States, 1938–2013. City or county was not available for 1 outbreak in Ohio; 1 in Iowa; 2 in Tennessee; 1 in Missouri; and 1 in North Carolina. Points were placed in the center of the state for these outbreaks. Three of the 5 outbreaks in Puerto Rico occurred in the same cave system and appear as a single point on the map. Histoplasmosis is a reportable disease in Arkansas, Delaware, Illinois, Indiana, Kentucky, Michigan, Minnesota, Nebraska, Pennsylvania, and Wisconsin.
Figure 4
Figure 4
Number of histoplasmosis outbreaks by onset month (reported for 86 of 105 outbreaks), United States, 1938–2013.
See this image and copyright information in PMC

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