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Endemic Mycoses:
Overlooked Diseases in China
TO THE EDITOR—We read with interest
the review authored by Lortholary et al
[1] that highlights the importance of
endemic fungal infections as potential
travel-related diseases. However, in the
Asia-Pacific region, the high-risk area of
endemic mycoses is elusive [2]. China,
the fourth-largest country in the world,
has become one of the world's most
popular tourist markets. We wish to
draw attention to the fact that increasing
number of cases of endemic mycoses
have been reported in China. These
mycoses include penicilliosis and histoplasmosis [3, 4].
To date, 668 cases of penicilliosis and
300 cases of histoplasmosis have been reported in China, most of which are autochthonous infections [3, 5]. Awareness of
the geographic distribution of these
diseases is valuable for preventing and
diagnosing travel-associated infections in
nonendemic areas. Infections due to
Penicillium marneffei have been mostly
reported from southern China, where
Guangxi and Guangdong provinces accounted for >80% of the reported cases
(Figure 1). Cao et al reported that in
Guangxi province alone, nearly 16% patients with AIDS are infected with P.
marneffei [4]. Although the potential
source of infection is rodent species, particularly bamboo rats, the route of transmission of P. marneffei to humans is still
unknown.
A geographic distribution analysis
showed that histoplasmosis is also
present throughout southern China [3].
This result was consistent with those of
earlier epidemiologic investigations that
utilized histoplasmin skin test. It is noteworthy that most cases of histoplasmosis
occurred in 9 provinces and regions
through which the Yangtze River flows
(Figure 1); Yunnan province accounted
for >27% of the reported cases of histoplasmosis [3]. However, no outbreak of
histoplasmosis occurred in China. China
is not a classical endemic area of histoplasmosis and the ecologic niche for this
infection remains unclear. This review
provides a clue for physicians whose
Figure 1. Geographic distribution of cases of penicilliosis and histoplasmosis reported in China (adapted from [3, 5]).
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patients have resided in or traveled to
these places in China.
In addition, 13 cases of coccidioidomycosis have been reported in China
[6–10]. Unlike penicilliosis and histoplasmosis, most cases of coccidioidomycosis were reported in returning travelers
[6]. Only 1 case patient was definitely
known to have acquired infection within
China, as he had never traveled outside
the country. This patient had choked on
water when diving into the sea in
Hainan province, which may be the possible infective route [8]. No case of Paracoccidioides infection has been reported
in China.
Notes
Financial support. This work was supported by a key project (AWS11L009) from Chinese
Military Logistics.
Potential conflicts of interest. All authors:
No reported conflicts.
All authors have submitted the ICMJE Form
for Disclosure of Potential Conflicts of Interest.
Conflicts that the editors consider relevant to
the content of the manuscript have been
disclosed
Bo Pan,1,2,3 Shuwen Deng,2,3 Wanqing Liao,2,3
and Weihua Pan1
1
Department of Dermatology, Changzheng Hospital,
Second Military Medical University; 2Institute of
Medical Mycology; and 3Shanghai Key Laboratory of
Molecular Medical Mycology, Shanghai, People's
Republic of China
References
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M, Consigny PH. Fungal infections in immunocompromised travelers. Clin Infect Dis
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2. Chakrabarti A, Slavin MA. Endemic fungal
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Correspondence: Weihua Pan, MD, Department of Dermatology, Changzheng Hospital, 415 Fengyang Road, Shanghai, PR
China ( [email protected]).
Clinical Infectious Diseases 2013;56(10):1516–7
© The Author 2013. Published by Oxford University Press
on behalf of the Infectious Diseases Society of America. All
rights reserved. For Permissions, please e-mail: journals.
[email protected].
DOI: 10.1093/cid/cit033
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