Abstract
Endemic fungi are thermally dimorphic fungi that have a limited geographic range and can cause both primary disease and opportunistic infections. The Americas are home to more genera of endemic fungi than anywhere else on earth. These include Coccidioides, Histoplasma, Blastomyces, Paracoccidioides, and Sporothrix. Endemic fungi are found across the Americas and the Caribbean, from Blastomyces gilchristi, which extends into the northeast corners of North America, to Histoplasma capsulatum, which occurs all the way down in the southern regions of South America and into the Caribbean Islands. Symptoms of endemic fungal infection, when present, mimic those of many other diseases and are often diagnosed only after initial treatment for a bacterial or viral disease has failed. Endemic fungi place a significant medical burden on the populations they affect, especially in immunocompromised individuals and in resource-limited settings. This review summarizes the ecology, geographical range, epidemiology, and disease forms of the endemic fungi found in the Americas. An emphasis is placed on new and proposed taxonomic changes, including the assignment of new species names in Histoplasma, Blastomyces, and Paracoccidioides.
Highlights
The Americas contain the largest number of dimorphic endemic fungal species, including Coccidioides species, Histoplasma capsulatum, Blastomyces species, Paracoccidioides species, and Sporothrix species
We summarize the taxonomy, ecology, geographic range, clinical features, and epidemiology of Coccidioides species, Histoplasma capsulatum, Blastomyces species, Paracoccidioides species, and Sporothrix species in the Americas
In 2010, three cases of coccidioidomycosis were reported in southeastern Washington State in people without travel history in the known endemic areas [17], and in 2014, C. immitis was detected in soil at the potential exposure site by PCR and culture [18]
Summary
The Americas contain the largest number of dimorphic endemic fungal species, including Coccidioides species, Histoplasma capsulatum, Blastomyces species, Paracoccidioides species, and Sporothrix species. The endemic fungi are so named because they have regional endemicity rather than being cosmopolitan like most fungi. They share the trait of being thermally dimorphic, growing as a mold in the environment at temperatures below. Low healthcare provider awareness, lack of clear diagnostic guidance, unavailability of diagnostic testing in some areas, and the fact that some fungal diagnostic test results can be challenging to interpret all suggest that these diseases are likely widely underdiagnosed. We summarize the taxonomy, ecology, geographic range, clinical features, and epidemiology of Coccidioides species, Histoplasma capsulatum, Blastomyces species, Paracoccidioides species, and Sporothrix species in the Americas
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