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Multistate Epidemiology of Histoplasmosis, United States, 2011-2014

Paige A Armstrong et al. Emerg Infect Dis. 2018 Mar.

Abstract

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.

Keywords: United States; epidemiology; fungi; histoplasmosis; mycoses; surveillance.

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Figures

Figure 1
Figure 1
Annual state-specific histoplasmosis incidence (no. cases/100,000 population) for the 5 US states in which incidence was highest, 2011–2014.
Figure 2
Figure 2
County-specific histoplasmosis incidence (no. cases/100,000 population) for the 12 US states from which surveillance data were available, 2011–2014.
See this image and copyright information in PMC

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