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Assessment of Prior Infection With Histoplasmosis Using Skin Test and Serological Surveys: A Global Systematic Review
Rachael A Brooks1, Kelly Yan1, Jennifer R Head1,2
1Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Background:
Evidence suggests geographic expansion in histoplasmosis, a fungal infection caused by Histoplasma spp. Establishing historical and modern population immunity to histoplasmosis is needed to contextualize future trends and ensure that providers give it diagnostic consideration.
Methods:
To summarize what is known regarding the distribution of histoplasmosis globally, we conducted a systematic review of studies reporting prevalence of lifetime or recent exposure to Histoplasma spp, assessed via skin or serological tests, respectively.
Results:
We included 224 studies, including 171 skin test surveys and 44 serological surveys, spanning 66 countries and all 6 World Health Organization regions. Prevalence of infection exceeded 10% in studies from the Americas, Southeast Asia, and Africa, with substantial variation across population subgroups. Most studies used nonrepresentative sampling.
Conclusions:
Histoplasmosis likely exists along a global gradient. Surveillance and research efforts must shift to address its broad distribution and ensure timely diagnosis and treatment, especially in areas not traditionally considered endemic.
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