Acute Care/Hospitalization

Study details the prevalence of and deaths from the most common pulmonary fungal infections in immunocompetent people

The major endemic fungal infections (mycoses) that occur in the United States include histoplasmosis, blastomycosis, and coccidioidomycosis. Although they occur primarily in the soil or other environs of distinct geographic areas, these pathogens can be found in all regions of the United States. They are the most common pulmonary fungal infections in immunocompetent people, with one-fourth of such infections severe enough to require hospitalization.

According to a new study, supported in part by the Agency for Healthcare Research and Quality (HS00002), an estimated 332 pediatric and 6,003 adult patients with endemic mycoses required hospitalization in 2002 (4.6 and 28.7 cases per 1 million children and adults, respectively). About 5 percent of children and 7 percent of adults died as a result of these infections. While 13 percent of all patients who died were immunocompromised, 87 percent were immunocompetent.

The researchers retrospectively examined data from the 2002 Nationwide Inpatient Sample, a national database of hospital inpatient stays, to describe the incidence and epidemiology of endemic mycoses requiring hospitalization. Overall, 17 percent of hospitalized children and 13 percent of hospitalized adults with endemic mycoses had a reported underlying immunocompromising condition (for example, bone marrow transplant, sickle cell disease, or cancer). The median duration of hospital stay was 5 days among children and 6 days among adults. The total hospital charges in 2002 for all children with endemic mycoses were about $18 million, whereas for adults charges were over $240 million.

Coccidioidomycosis mostly occurred in the southern and western regions of the country, and histoplasmosis generally occurred in the southern and midwestern States. Blastomycosis, largely found along the Ohio and Mississippi Rivers, occurred primarily in midwestern and southern regions. Obtaining a patient's complete travel history may be valuable in diagnosing these infections among patients with undiagnosed pulmonary symptoms.

See "Hospitalizations for endemic mycoses: A population-based national study," by Jaclyn H. Chu, M.H.S., Chris Feudtner, M.D., Ph.D., M.P.H., Kateri Heydon, M.S., and others, in the March 15, 2006, Clinical Infectious Diseases 42, pp. 822-825.

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