Epidemiological Survey on Histoplasmosis

The ECMM survey on histoplasmosis in Europe was set up in March 1997 to examine the epidemiology of this disease in Europe. It aimed to assess how frequently histoplasmosis occurred in Europe, where and how the infection was acquired, groups at risk, the causative organism, the methods by which the infection was diagnosed and what therapy patients received. The survey was carried out over a 5 year period, with information collected retrospectively from January 1995 to December 1997 and prospectively from January 1998 to December 1999. Members of eight countries participated in the survey, ECMM convenors were Prof. E. Glyn V. Evans and Ruth Ashbee (Mycology Reference Centre, Leeds, UK).

Overall, 127 cases were reported, with 70 occurring in the retrospective phase of the survey and 57 during the prospective phase. In the majority of cases, the patient had travelled to a known endemic area, although in a few cases there was no history of travel from their country of birth. The time that had elapsed between travel to endemic areas and presentation ranged from a few weeks to many years. Several of the patients from the UK had served in endemic areas during World War II and developed disseminated histoplasmosis after a delay of several decades, illustrating the importance of obtaining a lifelong travel history if histoplasmosis is sus pected. Commonly reported risk factors included exposure to birds, bats and caves and many patients had AIDS.

Methods of diagnosis varied between countries, with some using imaging techniques, whilst others favoured serological diagnosis. Treatment also varied between countries, ranging from none in those patients who had mild or asymptomatic disease, to long courses of systemic antifungals.

The number of cases reported from each country varied significantly and this is thought to be due to the ways in which the disease was diagnosed. In many instances, the diagnosis of histoplasmosis was incidental to other investigations. Because primary pulmonary histoplasmosis is often self-limiting, most cases will go undiagnosed and so the cases reported in the survey are likely to represent the ‘tip of the iceberg’. Interim data were presented at the ECMM meeting in Barcelona in 2000 as an oral presentation, and several national convenors have presented the data for their country as posters at the ECMM and other meetings. The overall data collected during the survey are currently being prepared for publication.

From Mycology Newsletter, 2003. P. 8

The results were reported in: Ashbee HR, Evans EGV, Viviani MA, Dupont B, Chryssanthou E, Surmont I, Tomsikova A, Vachkov P, Ener B, Zala J, Tintelnot K and the ECMM Working Group on Histoplasmosis. Histoplasmosis in Europe: Report on an Epidemiological Survey from the European Confederation of Medical Mycology. Medical Mycology 2008; 46(1): 57-65.