Enhancing Diagnosis and Awareness of Fungal Diseases

Fungal diseases, coccidioidomycosis, histoplasmosis, and blastomycosis significantly impact the lower respiratory system, mirroring bacterial or viral pneumonia symptoms, and complicating accurate diagnosis.

The COVID-19 pandemic altered healthcare-seeking actions, public health reporting, and the clinical handling of these fungal diseases. A drop in case reports initially in the pandemic and a spike in blastomycosis mortality, enhanced the need for increased fungal disease awareness and education among healthcare workers. Incorporating these fungi in pneumonia differential diagnosis is important.

“Yearly case count fluctuations and the unusual increase in the blastomycosis CFR in 2021 are potentially linked to the COVID-19 pandemic's impact on healthcare behaviors and public health practices,” according to the CDC. “This period's atypical data underscore the urgent need for further research to understand and mitigate the pandemic's indirect effects on fungal disease diagnosis and management.”¹

CDC analysis from 2019-2021 showed 59,655 coccidioidomycosis cases, 3,595 histoplasmosis, and 719 blastomycosis. A spring 2020 decrease in cases across all infections, with most reported in the fall, and a 2021 blastomycosis case fatality rate rise to 17% from the usual 8%-10%, indicate the pandemic's impact.

According to previous reporting by Contagion, John Galgiani, MD, Professor of Medicine at the University of Arizona College of Medicine in Tucson, and director of The Valley Fever Center for Excellence at the University of Arizona stated,

“We could do better with diagnosing across the board year after year, I think statistics show that in the state of Arizona, appropriate testing in primary care and emergency rooms data that were generated in urgent care suggests that before 2020, it was less than 10% of people who should be tested were tested,” he continues. “I still think we should be up to 60% or 70% of testing those people so the effects that were illustrated by the CDC are swamped by what we could do better, just going forward on regular practice.”²

The CDC undertook an examination of case surveillance data from 2019 to 2021. This investigation sought to monitor the prevalence of these fungal infections and detect any shifts in their epidemiology that might be linked to the pandemic. The surveillance process entailed gathering and analyzing reported instances of these conditions from different areas, pinpointing trends and variations in the number of cases.

Limitations of the report include underreported case numbers due to diagnostic and reporting challenges, and difficulty distinguishing COVID-19 pandemic effects from other factors like climate or awareness due to incomplete data on exposures, testing, outcomes, and treatment. Inadequate data on demographics, hospitalizations, and deaths, and reliance on summary-level data for histoplasmosis and blastomycosis hinder detailed analysis.

The COVID-19 pandemic has enhanced challenges in handling these fungal infections, leading to fluctuating case counts and increased mortality. Enhanced respiratory illness preparedness, better healthcare provider education, and higher testing rates are crucial steps to mitigate the impact of these diseases. Improved data collection and analysis are needed to understand and address the fungal infections.

References

1. CDC. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic — United States, 2019–2021. Published March 21, 2024. Accessed April 4, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7311a2.htm?s_cid=mm7311a2_w
2. Abene, S. Soil to Lungs: The Expanding Threat of Valley Fever. Contagion. Published April 3, 2024. Accessed April 4, 2024. https://www.contagionlive.com/view/soil-to-lungs-climate-change-and-the-expanding-threat-of-valley-fever