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Volume 21, Number 11—November 2015

Mycotic Infections Acquired outside Areas of Known Endemicity, United States

Kaitlin BenedictComments to Author , George R. Thompson, Stan Deresinski, and Tom M. Chiller
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Benedict, T. Chiller); University of California Davis Medical Center, Davis, California, USA (G.R. Thompson III); University of California, Davis (G.R. Thompson III); Stanford University, Stanford, California, USA (S. Deresinski)

Main Article

Table 2

Advantages and disadvantages of potential strategies to refine areas of blastomycosis, coccidioidomycosis, and histoplasmosis endemicity

Strategy Advantages Disadvantages
Skin testing
Could cover large geographic areas; is likely to yield results that could be easily compared with early studies of skin test reactivity distribution
Availability, specificity, and cost of reagents may be limiting; may be difficult to identify persons who have no relevant travel history
Expand surveillance for fungal diseases in humans
Provides foundation for more comprehensive surveillance already in place in some states; would provide valuable information about the overall epidemiology of these diseases
Disease reporting can be time- and resource-intensive for state and local health departments; yield for areas of low or no endemicity is potentially low; not likely to capture information on asymptomatic infections; may be difficult to pinpoint location of exposure or rule out reactivation disease in persons who have extensive travel histories
Surveillance for fungal diseases in animals
Animals can be good sentinels for human disease because of potentially more extensive environmental exposures and limited travel
No comprehensive surveillance systems are currently in place; would be time and resource intensive to establish
Improved environmental detection
Detection of fungi in the environment can be a more direct measure of endemicity than disease data; positive results can provide a more definitive link between infection and the environment
Culture-based methods are insensitive; new technologies still in development; is challenging for large geographic areas
Additional ecologic niche modeling Leads to increased understanding of the fundamental niche for these fungi and locations where human or animal exposures could occur Model validity relies on the quality of reported locations of human and animal diseases, environmental sampling results, or both

Main Article

Page created: October 16, 2015
Page updated: October 16, 2015
Page reviewed: October 16, 2015
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