Saturday, December 9, 2023
| Characteristic | Arizona No. (%) | California No. (%) | Nevada, New Mexico, Utah, and Washington combined† No. (%) | Other states combined§ No. (%) | Total No. (%) |
|---|---|---|---|---|---|
| Sex (n = 20,034) | |||||
| Male | 4,679 (45) | 5,301 (59) | 243 (59) | 169 (59) | 10,392 (52) |
| Female | 5,668 (55) | 3,687 (41) | 168 (41) | 115 (41) | 9,638 (48) |
| Other | 0 (0) | 3 (0) | 1 (<1) | 0 (0) | 4 (0) |
| Age group (yrs) (n = 20,041) | |||||
| <1 | 0 (0) | 9 (0) | 0 (0) | 0 (0) | 9 (0) |
| 1–5 | 33 (<1) | 51 (1) | 1 (<1) | 0 (0) | 85 (<1) |
| 6–20 | 650 (6) | 706 (8) | 25 (6) | 6 (2) | 1,387 (7) |
| 21–40 | 2,111 (20) | 2,596 (29) | 71 (17) | 28 (10) | 4,806 (24) |
| 41–64 | 3,874 (37) | 3,754 (42) | 172 (42) | 111 (39) | 7,911 (40) |
| 65–80 | 2,925 (28) | 1,489 (17) | 126 (31) | 117 (41) | 4,657 (23) |
| >80 | 759 (7) | 386 (4) | 17 (4) | 24 (8) | 1,186 (6) |
| Race and ethnicity (n = 7,846) | |||||
| American Indian or Alaska Native, non-Hispanic | 177 (8) | 47 (1) | 16 (6) | 1 (<1) | 241 (3) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 72 (3) | 358 (7) | 11 (4) | 9 (5) | 450 (6) |
| Black, non-Hispanic | 161 (7) | 336 (6) | 16 (6) | 15 (8) | 528 (7) |
| Hispanic or Latino (all races) | 511 (23) | 1,972 (38) | 65 (26) | 11 (6) | 2,559 (33) |
| White, non-Hispanic | 1,260 (56) | 1,706 (33) | 140 (55) | 146 (77) | 3,252 (41) |
| Other¶ | 51 (2) | 752 (15) | 5 (2) | 8 (4) | 816 (10) |
| Total | 10,359 (100) | 9,004 (100) | 412 (100) | 286 (100) | 20,061 (100) |
Number and percentage of coccidioidomycosis cases, by area and selected patient characteristics* — 23 states, 2019
*Sex was missing for 27 cases, age was missing for 20 cases, and race and ethnicity was missing for 12,215 cases.
†
Coccidioides is known to be present in Nevada, New Mexico, Utah, and Washington, although these states report fewer cases than Arizona
and California.
§Refers to all other states where coccidioidomycosis is reportable and at least one case was reported in 2019 (Alabama, Arkansas,
Delaware, Indiana, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, North Dakota,
Ohio, Oregon, Rhode Island, South Dakota, Wisconsin, and Wyoming).
¶Calculated on basis of two or more race category.
| Characteristic | Arizona | California | Nevada, New Mexico, Utah, and Washington combined§ | Other states combined¶ | Total |
|---|---|---|---|---|---|
| Sex (n = 20,034) | |||||
| Male | 129.4 | 27.0 | 3.0 | 0.2 | 15.8 |
| Female | 154.8 | 18.6 | 2.1 | 0.1 | 14.4 |
| Age group (yrs) (n = 20,041) | |||||
| <1 | 0 | 2.0 | 0 | 0 | 0.6 |
| 1–5 | 7.5 | 2.1 | 0.1 | 0 | 1.0 |
| 6–20 | 45.9 | 9.4 | 0.8 | 0.1 | 5.5 |
| 21–40 | 107.7 | 22.6 | 1.6 | 0.2 | 13.2 |
| 41–64 | 186.8 | 31.9 | 3.7 | 0.5 | 19.9 |
| 65–80 | 280.6 | 32.6 | 6.4 | 1.2 | 27.3 |
| >80 | 285.2 | 30.3 | 3.7 | 1.0 | 26.2 |
| Race and ethnicity (n = 7,846) | |||||
| American Indian or Alaska Native, non-Hispanic | 61.7 | 29.0 | 4.7 | 0.2 | 17.4 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 27.4 | 6.0 | 1.0 | 0.4 | 4.6 |
| Black, non-Hispanic | 49.4 | 15.1 | 2.4 | 0.2 | 4.0 |
| Hispanic or Latino (all races) | 24.6 | 14.1 | 2.2 | 0.3 | 11.2 |
| White, non-Hispanic | 32.0 | 11.8 | 1.4 | 0.3 | 4.1 |
| Other** | 33.4 | 67.5 | 1.0 | 0.5 | 24.6 |
| Total | 142.3 | 22.8 | 2.6 | 0.4 | 15.1 |
Incidence rate* of coccidioidomycosis, by area and selected patient characteristics† — 23 states, 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arizona
and California incidence rates. Pooled state-specific denominators from estimated 2019 U.S. Census Bureau data were used for
the respective incidence rates of the Nevada, New Mexico, Utah, and Washington combined grouping; other states combined grouping;
and the total grouping. U.S. Census Bureau data were not available to calculate incidence rate for sex category "other" (three
cases in California and one case in Nevada, New Mexico, Utah, and Washington combined).
†Sex was missing for 27 cases, age was missing for 20 cases, and race and ethnicity was missing for 12,215 cases.
§
Coccidioides is known to be present in Nevada, New Mexico, Utah, and Washington, although these states report fewer cases than Arizona
and California.
¶Refers to all other states where coccidioidomycosis is reportable and at least one case was reported in 2019 (Alabama, Arkansas,
Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oregon, Rhode Island,
South Dakota, Wisconsin, and Wyoming).
**Calculated on basis of two or more races category.
| Characteristic | Arkansas No. (%) | Delaware No. (%) | Illinois No. (%) | Indiana No. (%) | Kansas No. (%) | Kentucky No. (%) | Louisiana No. (%) | Michigan No. (%) | Minnesota No. (%) | Nebraska No. (%) | Pennsylvania No. (%) | Wisconsin No. (%) | Total No. (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sex (n = 1,119) | |||||||||||||
| Male | 45 (48) | 0 (0) | 160 (55) | 61 (57) | 7 (50) | 30 (65) | 12 (60) | 133 (59) | 133 (62) | 29 (43) | 7 (44) | 14 (58) | 631 (56) |
| Female | 49 (52) | 0 (0) | 131 (45) | 46 (43) | 7 (50) | 16 (35) | 8 (40) | 92 (41) | 81 (38) | 39 (57) | 9 (56) | 10 (42) | 488 (44) |
| Age group (yrs) (n = 1,124) | |||||||||||||
| <1 | 0 (0) | 0 (0) | 0 (0) | 2 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (<1) |
| 1–5 | 2 (2) | 0 (0) | 1 (<1) | 2 (2) | 0 (0) | 0 (0) | 1 (5) | 1 (<1) | 2 (1) | 0 (0) | 0 (0) | 0 (0) | 9 (1) |
| 6–20 | 15 (16) | 0 (0) | 34 (12) | 23 (21) | 0 (0) | 7 (15) | 2 (10) | 17 (8) | 22 (10) | 8 (12) | 0 (0) | 4 (17) | 132 (12) |
| 21–40 | 32 (34) | 1 (100) | 79 (27) | 36 (33) | 1 (7) | 11 (24) | 9 (43) | 60 (27) | 51 (24) | 18 (27) | 2 (13) | 3 (13) | 303 (27) |
| 41–64 | 25 (26) | 0 (0) | 119 (41) | 28 (26) | 9 (64) | 22 (48) | 7 (33) | 101 (45) | 83 (39) | 29 (43) | 8 (50) | 9 (38) | 440 (39) |
| 65–80 | 20 (21) | 0 (0) | 49 (17) | 14 (13) | 3 (21) | 5 (11) | 2 (10) | 41 (18) | 50 (23) | 12 (18) | 5 (31) | 8 (33) | 209 (19) |
| >80 | 1 (1) | 0 (0) | 10 (3) | 3 (3) | 1 (7) | 1 (2) | 0 (0) | 5 (2) | 6 (3) | 1 (2) | 1 (6) | 0 (0) | 29 (3) |
| Race and ethnicity (n = 859) | |||||||||||||
| American Indian or Alaska Native, non-Hispanic | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (<1) | 1 (<1) | 2 (3) | 0 (0) | 0 (0) | 4 (<1) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1 (2) | 0 (0) | 7 (3) | 2 (2) | 1 (8) | 0 (0) | 9 (47) | 0 (0) | 5 (3) | 0 (0) | 0 (0) | 0 (0) | 25 (3) |
| Black, non-Hispanic | 12 (21) | 0 (0) | 34 (17) | 15 (16) | 0 (0) | 0 (0) | 1 (5) | 8 (5) | 5 (3) | 3 (5) | 1 (14) | 0 (0) | 79 (9) |
| Hispanic or Latino (all races) | 5 (9) | 0 (0) | 27 (13) | 5 (5) | 0 (0) | 2 (8) | 7 (37) | 7 (4) | 3 (2) | 4 (6) | 1 (14) | 2 (9) | 63 (7) |
| White, non-Hispanic | 38 (68) | 0 (0) | 133 (66) | 70 (73) | 12 (92) | 22 (88) | 2 (11) | 137 (77) | 159 (92) | 58 (87) | 5 (71) | 20 (91) | 656 (76) |
| Other§ | 0 (0) | 0 (0) | 2 (4) | 4 (7) | 0 (0) | 1 (2) | 0 (0) | 25 (45) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 32 (4) |
| Hospitalization (n = 460) | |||||||||||||
| Yes | 36 (69) | —¶ | — | 62 (63) | 10 (71) | — | — | — | 101 (49) | 27 (42) | — | 13 (54) | 249 (54) |
| No | 16 (31) | — | — | 36 (37) | 4 (29) | — | — | — | 107 (51) | 37 (58) | — | 11 (46) | 211 (46) |
| Death (n = 415) | |||||||||||||
| Yes | 2 (8) | — | — | 5 (5) | 2 (14) | — | — | — | 10 (5) | 1 (2) | — | 0 (0) | 20 (5) |
| No | 23 (92) | — | — | 93 (95) | 12 (86) | — | — | — | 196 (95) | 47 (98) | — | 24 (100) | 395 (95) |
| Total | 95 (100) | 1 (100) | 292 (100) | 108 (100) | 14 (100) | 46 (100) | 21 (100) | 225 (100) | 214 (100) | 68 (100) | 16 (100) | 24 (100) | 1,124 (100) |
Number and percentage of histoplasmosis cases, by state, selected patient characteristics, and clinical outcomes* — 12 states,† 2019
*Sex was missing for five cases, race and ethnicity was missing for 265 cases, hospitalization status was missing for 664
cases, and death status was missing for 709 cases.
†Rhode Island reported zero cases in 2019.
§Calculated on basis of two or more race category.
¶Not available.
| Characteristic | Arkansas | Delaware | Illinois | Indiana | Kansas | Kentucky | Louisiana | Michigan | Minnesota | Nebraska | Pennsylvania | Wisconsin | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sex (n = 1,119) | |||||||||||||
| Male | 3.0 | 0 | 2.6 | 1.8 | 0.5 | 1.4 | 0.5 | 2.7 | 4.7 | 3.0 | 0.1 | 0.5 | 1.8 |
| Female | 3.2 | 0 | 2.0 | 1.4 | 0.5 | 0.7 | 0.3 | 1.8 | 2.9 | 4.0 | 0.1 | 0.3 | 1.3 |
| Age group (yrs) (n = 1,124) | |||||||||||||
| <1 | 0 | 0 | 0 | 2.5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0.2 |
| 1–5 | 1.1 | 0 | 0.1 | 0.5 | 0 | 0 | 0.3 | 0.2 | 0.6 | 0 | 0 | 0 | 0.2 |
| 6–20 | 2.5 | 0 | 1.4 | 1.7 | 0 | 0.8 | 0.2 | 0.9 | 2.0 | 2.0 | 0 | 0.4 | 1.0 |
| 21–40 | 4.1 | 0.4 | 2.3 | 2.0 | 0.1 | 1.0 | 0.7 | 2.3 | 3.4 | 3.5 | 0.1 | 0.2 | 1.6 |
| 41–64 | 2.8 | 0 | 3.1 | 1.4 | 1.1 | 1.6 | 0.5 | 3.3 | 4.9 | 5.3 | 0.2 | 0.5 | 2.0 |
| 65–80 | 4.8 | 0 | 3.1 | 1.6 | 0.8 | 0.8 | 0.3 | 2.9 | 7.0 | 5.0 | 0.3 | 1.0 | 2.2 |
| >80 | 0.9 | 0 | 2.2 | 1.3 | 0.9 | 0.7 | 0 | 1.4 | 2.9 | 1.4 | 0.2 | 0 | 1.1 |
| Race and ethnicity (n = 859) | |||||||||||||
| American Indian or Alaska Native, non-Hispanic | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1.8 | 1.7 | 12.3 | 0 | 0 | 1.2 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1.7 | 0 | 1.0 | 1.2 | 1.1 | 0 | 10.8 | 0 | 1.7 | 0 | 0 | 0 | 1.0 |
| Black, non-Hispanic | 2.6 | 0 | 1.9 | 2.3 | 0 | 0 | 0.1 | 0.6 | 1.3 | 3.2 | 0.1 | 0 | 0.9 |
| Hispanic or Latino (all races) | 2.4 | 0 | 1.3 | 1.2 | 0 | 1.3 | 3.4 | 1.6 | 1.1 | 2.1 | 0.1 | 0.6 | 1.2 |
| White, non-Hispanic | 1.8 | 0 | 1.7 | 1.3 | 0.6 | 0.6 | 0.1 | 1.8 | 3.6 | 3.8 | 0.1 | 0.4 | 1.3 |
| Other¶ | 0 | 0 | 1.0 | 3.1 | 0 | 1.2 | 0 | 11.0 | 0 | 0 | 0 | 0 | 2.3 |
| Total | 3.2 | 0.1 | 2.3 | 1.6 | 0.5 | 1.0 | 0.5 | 2.3 | 3.8 | 3.5 | 0.1 | 0.3 | 1.6 |
Incidence rate* of histoplasmosis, by state and selected patient characteristics† — 12 states,§ 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arkansas,
Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Nebraska, Pennsylvania, and Wisconsin incidence
rates. Pooled state-specific denominators from estimated 2019 U.S. Census Bureau data were used to calculate the incidence
rate for the total grouping.
†Sex was missing for five cases, and race and ethnicity was missing for 265 cases.
§Rhode Island reported zero cases in 2019.
¶Calculated on basis of two or more race category.
| Characteristic | Arkansas No. (%) | Louisiana No. (%) | Michigan No. (%) | Minnesota No. (%) | Wisconsin No. (%) | Total No. (%) |
|---|---|---|---|---|---|---|
| Sex (n = 239) | ||||||
| Male | 18 (64) | 7 (100) | 17 (65) | 56 (71) | 70 (71) | 168 (70) |
| Female | 10 (36) | 0 (0) | 9 (35) | 23 (29) | 29 (29) | 71 (30) |
| Age group (yrs) (n = 240) | ||||||
| <1 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| 1–5 | 1 (4) | 0 (0) | 0 (0) | 1 (1) | 0 (0) | 2 (1) |
| 6–20 | 8 (29) | 0 (0) | 0 (0) | 6 (8) | 10 (10) | 24 (10) |
| 21–40 | 6 (21) | 2 (29) | 4 (15) | 37 (47) | 30 (30) | 79 (33) |
| 41–64 | 11 (39) | 2 (29) | 13 (50) | 22 (28) | 42 (42) | 90 (38) |
| 65–80 | 2 (7) | 3 (43) | 8 (31) | 13 (16) | 15 (15) | 41 (17) |
| >80 | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 3 (3) | 4 (2) |
| Race and ethnicity (n = 208) | ||||||
| American Indian or Alaska Native, non-Hispanic | 0 (0) | 0 (0) | 1 (5) | 5 (7) | 4 (5) | 10 (5) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1 (5) | 0 (0) | 0 (0) | 8 (11) | 6 (7) | 15 (7) |
| Black, non-Hispanic | 3 (15) | 2 (100) | 1 (5) | 7 (9) | 11 (13) | 24 (12) |
| Hispanic or Latino (all races) | 3 (15) | 0 (0) | 1 (5) | 4 (5) | 6 (7) | 14 (7) |
| White, non-Hispanic | 13 (65) | 0 (0) | 19 (86) | 52 (68) | 60 (68) | 144 (69) |
| Other† | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1) | 1 (1) |
| Hospitalization (n = 228) | ||||||
| Yes | 14 (82) | 5 (83) | 16 (62) | 51 (65) | 61 (61) | 147 (65) |
| No | 3 (18) | 1 (17) | 10 (38) | 28 (35) | 39 (39) | 81 (36) |
| Death (n = 224) | ||||||
| Yes | 1 (8) | 2 (29) | 3 (12) | 5 (6) | 9 (9) | 20 (9) |
| No | 11 (92) | 5 (71) | 23 (88) | 74 (94) | 91 (91) | 204 (91) |
| Total | 28 (100) | 7 (100) | 26 (100) | 79 (100) | 100 (100) | 240 (100) |
Number and percentage of blastomycosis cases, by state, selected patient characteristics, and clinical outcomes* — five states, 2019
*Sex was missing for one case, race and ethnicity was missing for 32 cases, hospitalization status was missing for 12 cases,
and death status was missing for 16 cases.
†Calculated on basis of two or more race category.
| Characteristic | Arkansas | Louisiana | Michigan | Minnesota | Wisconsin | Total |
|---|---|---|---|---|---|---|
| Sex (n = 239) | ||||||
| Male | 1.2 | 0.3 | 0.4 | 1.9 | 2.4 | 1.2 |
| Female | 0.7 | 0 | 0.2 | 0.8 | 1.0 | 0.5 |
| Age group (yrs) (n = 240) | ||||||
| <1 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1–5 | 0.5 | 0 | 0 | 0.3 | 0 | 0.1 |
| 6–20 | 1.4 | 0 | 0 | 0.6 | 0.9 | 0.5 |
| 21–40 | 0.8 | 0.2 | 0.3 | 2.5 | 2.0 | 1.3 |
| 41–64 | 1.2 | 0.2 | 0.8 | 1.3 | 2.3 | 1.2 |
| 65–80 | 0.5 | 0.5 | 1.1 | 1.8 | 1.9 | 1.3 |
| >80 | 0 | 0 | 0.4 | 0 | 1.4 | 0.2 |
| Race and ethnicity (n = 208) | ||||||
| American Indian or Alaska Native, non-Hispanic | 0 | 0 | 1.8 | 8.3 | 7.6 | 4.5 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 2.1 | 0 | 0 | 2.7 | 3.4 | 1.6 |
| Black, non-Hispanic | 0.7 | 0.1 | 0.1 | 1.8 | 3.0 | 0.6 |
| Hispanic or Latino (all races) | 1.4 | 0 | 0.2 | 1.5 | 1.7 | 0.9 |
| White, non-Hispanic | 0.6 | 0 | 0.3 | 1.2 | 1.3 | 0.7 |
| Other§ | 0 | 0 | 0 | 0 | 1.0 | 0.2 |
| Total | 0.9 | 0.2 | 0.3 | 1.4 | 1.7 | 0.8 |
Incidence rate* of blastomycosis, by state and selected patient characteristics† — five states, 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arkansas,
Louisiana, Michigan, Minnesota, and Wisconsin incidence rates. Pooled state-specific denominators from estimated 2019 U.S.
Census Bureau data were used to calculate the incidence rate for the total grouping.
†Sex was missing for one case, race and ethnicity was missing for 32 cases, hospitalization status was missing for 12 cases,
and death status was missing for 16 cases.
§Calculated on basis of two or more race category.
Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.75 ABIM MOC points
Nurses - 0.75 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.75 Knowledge-based ACPE (0.075 CEUs)
This activity is intended for public health officials, infectious disease clinicians, internists, pulmonologists, nurses, pharmacists, and other clinicians caring for patients with or at risk for coccidioidomycosis, histoplasmosis, or blastomycosis.
The goal of this activity is for learners to be better able to describe geographic distribution, populations at risk, and seasonality of coccidioidomycosis, histoplasmosis, and blastomycosis, according to 2019 US surveillance data.
Upon completion of this activity, participants will:
Medscape, LLC designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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CME / ABIM MOC / CE Released: 12/19/2022
Valid for credit through: 12/19/2023, 11:59 PM EST
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Problem/Condition: Coccidioidomycosis, histoplasmosis, and blastomycosis are underdiagnosed fungal diseases that often mimic bacterial or viral pneumonia and can cause disseminated disease and death. These diseases are caused by inhalation of fungal spores that have distinct geographic niches in the environment (e.g., soil or dust), and distribution is highly susceptible to climate changes such as expanding arid regions for coccidioidomycosis, the northward expansion of histoplasmosis, and areas like New York reporting cases of blastomycosis previously thought to be nonendemic. The national incidence of coccidioidomycosis, histoplasmosis, and blastomycosis is poorly characterized.
Reporting Period: 2019.
Description of System: The National Notifiable Diseases Surveillance System (NNDSS) tracks cases of coccidioidomycosis, a nationally notifiable condition reported to CDC by 26 states and the District of Columbia. Neither histoplasmosis nor blastomycosis is a nationally notifiable condition; however, histoplasmosis is voluntarily reported in 13 states and blastomycosis in five states. Health departments classify cases based on the definitions established by the Council of State and Territorial Epidemiologists.
Results: In 2019, a total of 20,061 confirmed coccidioidomycosis, 1,124 confirmed and probable histoplasmosis, and 240 confirmed and probable blastomycosis cases were reported to CDC. Arizona and California reported 97% of coccidioidomycosis cases, and Minnesota and Wisconsin reported 75% of blastomycosis cases. Illinois reported the greatest percentage (26%) of histoplasmosis cases. All three diseases were more common among males, and the proportion for blastomycosis (70%) was substantially higher than for histoplasmosis (56%) or coccidioidomycosis (52%). Coccidioidomycosis incidence was approximately four times higher for non-Hispanic American Indian or Alaska Native (AI/AN) persons (17.3 per 100,000 population) and almost three times higher for Hispanic or Latino persons (11.2) compared with non-Hispanic White (White) persons (4.1). Histoplasmosis incidence was similar across racial and ethnic categories (range: 0.9–1.3). Blastomycosis incidence was approximately six times as high among AI/AN persons (4.5) and approximately twice as high among non-Hispanic Asian and Native Hawaiian or other Pacific Islander persons (1.6) compared with White persons (0.7). More than one half of histoplasmosis (54%) and blastomycosis (65%) patients were hospitalized, and 5% of histoplasmosis and 9% of blastomycosis patients died. States in which coccidioidomycosis is not known to be endemic had more cases in spring (March, April, and May) than during other seasons, whereas the number of cases peaked slightly in autumn (September, October, and November) for histoplasmosis and in winter (December, January, and February) for blastomycosis.
Interpretation: Coccidioidomycosis, histoplasmosis, and blastomycosis are diseases occurring in geographical niches within the United States. These diseases cause substantial illness, with approximately 20,000 coccidioidomycosis cases reported in 2019. Although substantially fewer histoplasmosis and blastomycosis cases were reported, surveillance was much more limited and underdiagnosis was likely, as evidenced by high hospitalization and death rates. This suggests that persons with milder symptoms might not seek medical evaluation and the symptoms self-resolve or the illnesses are misdiagnosed as other, more common respiratory diseases.
Public Health Action: Improved surveillance is necessary to better characterize coccidioidomycosis severity and to improve detection of histoplasmosis and blastomycosis. These findings might guide improvements in testing practices that enable timely diagnosis and treatment of fungal diseases. Clinicians and health care professionals should consider coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia or other acute infections of the lower respiratory tract who live in or have traveled to areas where the causative fungi are known to be present in the environment. Culturally appropriate tailored educational messages might help improve diagnosis and treatment. Public health response to these three diseases is hindered because information gathered from states' routine surveillance does not include data on populations at risk and sources of exposure. Broader surveillance that includes expansion to other states, and more detail about potential exposures and relevant host factors can describe epidemiologic trends, populations at risk, and disease prevention strategies.
Coccidioidomycosis, histoplasmosis, and blastomycosis are fungal diseases that can infect anyone, regardless of immune status, and can progress to life-threatening severe pulmonary or disseminated disease.[1–3] Infections are typically acquired by inhalation of fungal spores from the environment, often in soil or dust. Climate change has the potential to expand the geographic range of coccidioidomycosis, histoplasmosis, and blastomycosis in the United States and globally.[4–7] Coccidioidomycosis, also known as Valley fever and caused by Coccidioides immitis and Coccidioides posadasii, is most commonly acquired in the southwestern United States, although it is also acquired as far north as Washington (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/118602). Histoplasmosis, caused by Histoplasma capsulatum, is acquired primarily in central and eastern states, although the disease likely also occurs to lesser extents across much of the country (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/118603). Blastomycosis, caused primarily by Blastomyces dermatitidis and Blastomyces gilchristii, is found in midwestern, south-central, and southeastern states (Supplementary Figure 3, https://stacks.cdc.gov/view/cdc/118604).[8–11] The recently described Blastomyces helicus has been found to cause illness in the western United States but remains poorly understood.[12] National surveillance of coccidioidomycosis, histoplasmosis, and blastomycosis can identify sources of disease and exposures among persons living in areas where the diseases are not known to be endemic. More information about the estimated areas with the fungi that cause coccidioidomycosis, histoplasmosis, and blastomycosis is available at https://www.cdc.gov/fungal/pdf/more-information-about-fungal-maps-508.pdf.
Coccidioidomycosis, histoplasmosis, and blastomycosis are frequently misdiagnosed as community-acquired pneumonia or other acute lower respiratory tract infections. Misdiagnoses can lead to inappropriate therapy with antibacterial medications and delayed antifungal treatment.[8,13,14] Antifungal treatment is recommended based on clinical manifestation and severity of disease.[2,15,16] Persons with weakened immune systems are at higher risk for severe disease; epidemiologic studies suggest that Black and Pacific Islander persons are also at higher risk for severe disease, and further study is needed to determine the reasons.[17–27] Diagnosis of these diseases is complex because of variable clinical presentation, nonspecific chest imaging findings, and resource-intensive diagnostic tests.[28,29]
Previously, each of these diseases has been described separately.[8,30,31] This report summarizes 2019 U.S. surveillance data on coccidioidomycosis, histoplasmosis, and blastomycosis to examine and compare geographic distribution, populations at risk, and seasonality. The findings in this report can be used to raise awareness among public health professionals, health care providers, policymakers, and the public to improve timely diagnosis and treatment.
