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Climate change is expanding the spread of valley fever and other fungal diseases beyond typical hot spots – ScienceDaily

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Infectious disease specialist George Thompson has been studying and treating fungal diseases for more than two decades. It tracks their prevalence, symptoms and relative risks. Lately, he’s been more concerned about a growing threat: the spread of disease-causing fungi beyond their traditional hotspots.

In a comment published in Annals of Internal Medicine, Thompson and co-author Tom Chiller of the Centers for Disease Control and Prevention’s Division of Mycotic Diseases sounded the alarm. They noted the increased presence and new risks of three endemic fungal diseases: histoplasmosis, blastomycosis, and coccidioidomycosis (valley fever).

“These three fungal diseases typically inhabit certain regions of the U.S. that are conducive to their survival,” Thompson said. He is a professor in the Department of Internal Medicine, Division of Infectious Diseases, and Department of Medical Microbiology and Immunology at UC Davis School of Medicine. “Recently, we are discovering more and more cases of these diseases outside their known territories, catching doctors and patients by surprise.”

Fungal infections are a new global threat

Fungi are microorganisms that are found in large numbers in nature. These include yeasts, molds, fungi and more. Although most fungi are harmless to humans, some can cause diseases (known as mycoses) that can harm patients and the health care system.

The World Health Organization (WHO) recently published its list of priority fungal pathogens, identifying fungi of greatest concern that may cause infections for which there is drug resistance or other treatment problems. These pathogens are predicted to cause even greater problems over the next decade.

Climate change increases the spread of fungal infections

Endemic fungi traditionally have a distinct geographic distribution. Changes in climate temperature and rainfall affect where these fungi thrive.

The authors noted the expansion of regions where endemic fungi are found. Valley fever, for example, was found in Nebraska, east of the traditional hot spots in California and Arizona.

“These organisms are probably much more common than we originally thought. Clinicians unfamiliar with these organisms are increasingly likely to encounter them in their daily practice,” said Thompson.

Clinicians commonly miss the diagnosis of a fungal infection

The three endemic mycoses have many symptoms, including fever, chills, cough, night sweats, and fatigue. They can also cause lung infections that mimic pneumonia. Therefore, they can easily be mistaken for more common viral and bacterial lung infections.

Current American Thoracic Society and American Infectious Diseases Society pneumonia guidelines do not offer specific recommendations for testing or treatment of endemic mycosis. Most medical practitioners may have little experience in recognizing and treating these fungal lung infections.

About 20% of pneumonia cases in parts of California and Arizona are caused by valley fever. However, it usually takes more than three weeks after the onset of symptoms to make a correct diagnosis. Diagnosis of histoplasmosis and blastomycosis can take even longer.

Fungal infections are also often misdiagnosed as bacterial. With such a misdiagnosis, the patient is prescribed antibiotics, which are ineffective for fungal diseases. It also exposes them to unnecessary medications and contributes to the rise of antimicrobial resistance in society. The authors urged doctors to carefully examine travel history and perform additional tests to rule out a fungal infection before giving patients a second round of antibiotics.

“In regions where these fungal diseases thrive, physicians should consider diagnosing and testing for mycosis in all patients with suggestive disease,” Thompson recommended.

The authors identified several factors that may contribute to these delays in diagnosis and treatment. One of them is the difference in the knowledge of clinicians about the diagnosis and treatment of the disease. Another is the lack of point diagnostics. Panels commonly used to diagnose respiratory infections do not include endemic mycoses. Tests for serum antibodies and urine antigens for endemic mycosis are usually available only in certain laboratories.

Action plan for combating endemic mycoses

The authors see an opportunity to improve the practice of fungal diagnosis and treatment through better surveillance and continuing medical education for these regional infections. They proposed a multifaceted approach to aid in the prevention, early detection, and treatment of these diseases. They called:

1) national surveillance and reporting of endemic mycoses in both humans and animals

2) educational efforts for patients and providers

3) inclusion of endemic mycoses in future pneumonia guidelines

4) development of diagnostic tools for medical care

5) the study of panendemic vaccines against mycoses for the prevention of infection

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