Close encounters of three kinds: Case-based report of endemic mycoses in the environs of New York city

The term “endemic mycoses” refers to a group of fungi that maintains a baseline rate of infection only in certain geographical regions due to the hospitable enviormental conditions these regions offer. In the United States, Histoplasma capsulatum, Coccidioides spp, and Blastomyces dermatitidis are the three most prevalent endemic human fungal infections. The traditional endemic regions for these pathogens are defined based on data acquired many decades ago, and case detection is subject to diagnostic delays even in classically endemic areas, a problem that is likely to be magnified in areas less familiar with these fungal infections. The present series includes an example of each of these infections diagnosed in a medical center situated in the suburbs of New York City, a location not considered endemic for any of them. Likely routes of acquisition for the three patients are considered, and the history of encounters with these pathogens in New York State is briefly recounted. Altogether, this report is intended to serve as a reminder to clinicians that traditional distribution maps for the endemic mycoses are bound to be outdated in the face of modern trends in globalization, population dynamics, and ecological change.