Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update

Abstract

Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.

Keywords: Blastomycosis; Coccidioidomycosis; Histoplasmosis; Paracoccidioidomycosis; Systemic mycoses; Talaromycosis.

Fig. 1

Literature selection procedure

Fig. 2

Coccidioides immitis. A Coccidial spherules through direct microscopy. B Colonies grown on Sabouraud dextrose agar after three days of incubation. [Courtesy of Chiara Savio]

Fig. 3

Histoplasma capsulatum. A Yeast cells with Gomori methenamine silver stain. B Blastoconidia inside a macrophage (Giemsa stain). [Courtesy of Stefano Andreoni, Claudio Farina, Gianluigi Lombardi]

Fig. 4

Countries of infection acquisition