Recent Trends in the Epidemiology of Fungal Infections

Abstract

The breadth of fungi causing human disease and the spectrum of clinical presentations associated with these infections has widened. Epidemiologic trends display dramatic shifts with expanding geographic ranges, identification of new at-risk groups, increasing prevalence of resistant infections, and emergence of novel multidrug-resistant pathogenic fungi. Certain fungi have been transmitted between patients in clinical settings. Major health events not typically associated with mycoses resulted in larger proportions of the population susceptible to secondary fungal infections. Many health care-related, environmental, and socioeconomic factors have influenced these epidemiologic shifts. This review summarizes updates to clinically significant fungal pathogens in North America.

Keywords: Aspergillus; Blastomyces; Candida; Coccidioides; Cryptococcus; Fungal diseases; Fungi; Histoplasma.

Fig. 1.

Reported U.S. Clinical Cases of C auris from 2013 to 2020. C auris began spreading in the United States in 2015; the earliest reported US cases were identified through a retrospective review. (From Centers for Disease Control and Prevention [CDC] unpublished data.)

Fig. 2.

Geographic representation of the 4 major C auris clades identified in the United States through 2019. Shading of certain countries is used to represent the geographic regions that the specific C auris clades are associated with, and does not represent direct introduction from these countries to the United States. (From Centers for Disease Control and Prevention [CDC]. Antibiotic Resistance Threats in the United States. 2019. Available at: http://www.cdc.gov/drugresistance/Biggest-Threats.html. Accessed February 23, 2021.)

Fig. 3.

Geographic distribution of blastomycosis, coccidioidomycosis and histoplasmosis in the United States. (From Centers for Disease Control and Prevention [CDC]. More information about the estimated areas with blastomycosis, coccidioidomycosis (Valley fever), and histoplasmosis in the United States. 2020. Available at: https://www.cdc.gov/fungal/pdf/more-information-about-fungal-maps-508.pdf. Accessed February 23, 2021.)