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Observational Study
. 2025 Jan;68(1):e70021.
doi: 10.1111/myc.70021.

Imported Systemic Endemic Mycoses in Spain 1997-2021: An Analysis of a National Hospital Database

Jara Llenas-García  1   2   3   4 , Roberto González Beiro  5   6 , José-Manuel Ramos-Rincón  3   7   8 , Philip Wikman-Jorgensen  3   4   9
Affiliations
Observational Study

Imported Systemic Endemic Mycoses in Spain 1997-2021: An Analysis of a National Hospital Database

Jara Llenas-García et al. Mycoses. 2025 Jan.

Abstract

Background: Systemic endemic mycoses are systemic fungal infections typically found in tropical and subtropical regions. Their global incidence is rising, including in nonendemic countries, mainly due to migration and international travel. They are a major cause of morbidity and mortality worldwide, especially in immunocompromised patients. This study aimed to analyse incidence trends of endemic mycoses and their presentation in hospitalised patients in Spain from 1997 to 2021.

Methods: This retrospective, observational study drew data from the Spanish National Hospital Discharge Database. We used the diagnostic codes of the 9th and 10th International Classification of Diseases for histoplasmosis, coccidioidomycosis, paracoccidioidomycosis and talaromycosis, retrieving systemic endemic mycoses cases from the national public registry.

Results: Over the study period, 646 cases of histoplasmosis, 138 of coccidioidomycosis, 47 of paracoccidioidomycosis and 24 talaromycosis were reported, with a rising number of cases annually, driven mainly by an increase in histoplasmosis. A segmented linear regression predictive model with a 10-year forecast showed a steady increase, reaching 128 hospitalisations (95% confidence interval [CI] 87-168) in Spain in 2031. Overall, in-hospital mortality was 10.9%, higher in histoplasmosis (11.3%) and coccidioidomycosis (10.9%) and independently associated with immunosuppression for both histoplasmosis (adjusted odds ratio [aOR] 3.28, 95% CI 1.72-6.24; p < 0.001) and coccidioidomycosis (aOR 4.05, 95% CI 1.22-13.44; p = 0.022).

Conclusions: Hospitalisations for systemic endemic mycoses, especially histoplasmosis, are on the rise in Spain. Mortality is significant and primarily associated with immunosuppression. This trend is expected to continue in the coming years, underscoring the importance of maintaining hospital-based surveillance of endemic mycoses in nonendemic regions.

Keywords: coccidioidomycosis; endemic mycoses; histoplasmosis; hospitalisations; immunosuppression; paracoccidioidomycosis; talaromycosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Age and sex distribution of patients with systemic endemic mycoses hospitalised in Spain, 1997–2021.
FIGURE 2
FIGURE 2
Systemic endemic mycoses cases per 100,000 pop. in Spain, by autonomous community, 1997–2021. (A) Total systemic endemic mycoses cases; (B) Histoplasmosis; (C) Coccidioidomycosis; (D) Paracoccidioidomycosis; (E) Talaromycosis.
FIGURE 3
FIGURE 3
Temporal analysis of hospitalisations for systemic endemic mycoses in Spain, 1997–2021.
FIGURE 4
FIGURE 4
Number of hospitalisations for systemic endemic mycoses in Spain per year, according to immunosuppression group, 1997–2021.
FIGURE 5
FIGURE 5
Segmented linear regression model to predict the trend of hospitalisations for systemic endemic mycoses in Spain to 2031. CI, confidence interval.
See this image and copyright information in PMC

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