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. 2018 Jul;24(7):1257-1266.
doi: 10.3201/eid2407.172063.

Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990-2015

Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990-2015

Elizabeth M Brown et al. Emerg Infect Dis. 2018 Jul.

Abstract

Endemic mycoses represent a growing public health challenge in North America. We describe the epidemiology of 1,392 microbiology laboratory-confirmed cases of blastomycosis, histoplasmosis, and coccidioidomycosis in Ontario during 1990-2015. Blastomycosis was the most common infection (1,092 cases; incidence of 0.41 cases/100,000 population), followed by histoplasmosis (211 cases) and coccidioidomycosis (89 cases). Incidence of blastomycosis increased from 1995 to 2001 and has remained elevated, especially in the northwest region, incorporating several localized hotspots where disease incidence (10.9 cases/100,000 population) is 12.6 times greater than in any other region of the province. This retrospective study substantially increases the number of known endemic fungal infections reported in Canada, confirms Ontario as an important region of endemicity for blastomycosis and histoplasmosis, and provides an epidemiologic baseline for future disease surveillance. Clinicians should include blastomycosis and histoplasmosis in the differential diagnosis of antibiotic-refractory pneumonia in patients traveling to or residing in Ontario.

Keywords: Blastomyces dermatitidis; Blastomyces gilchristii; Canada; Coccidioides immitis; Coccidioides posadasii; Histoplasma capsulatum; Ontario; blastomycosis; climate change; coccidioidomycosis; dimorphic fungi; fungi; geographic distribution; histoplasmosis.

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Figures

Figure 1
Figure 1
Geographic distribution of A) annualized incidence (no. cases/100,000 population) of blastomycosis (1995–2015) and B) no. cases of histoplasmosis (1990–2015) by Ontario Local Health Integration Network (LHIN), Ontario, Canada. 1, Erie St. Clair; 2, South West; 3, Waterloo Wellington; 4, Hamilton Niagara Haldimond Brant; 5, Central West; 6, Mississauga Halton; 7, Toronto Central; 8, Central; 9, Central East; 10, South East; 11, Champlain; 12, North Simcoe Muskoka; 13, North East; 14, North West. Incidence was calculated using LHIN-specific population denominators from Statistics Canada (36). Inset shows the location of Ontario within North America.
Figure 2
Figure 2
The number of cases (bars) and annual incidence (line) of microbiology laboratory–confirmed blastomycosis in Ontario, Canada, 1995–2015. Incidence was calculated using population denominators from Statistics Canada (36,37).
Figure 3
Figure 3
Geographic distribution of blastomycosis cases with known patient city and forward sortation area (first 3 characters of postal code) (n = 544) in Ontario, 1995–2015. Size of dot is proportional to number of cases at a given location.
Figure 4
Figure 4
The number of cases of microbiology laboratory–confirmed A) histoplasmosis and B) coccidioidomycosis in Ontario, Canada, 1990–2015.

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