The Epidemiological Features of Invasive Mycotic Infections in the San Francisco Bay Area, 1992-1993: Results of Population-Based Laboratory Active Surveillance

TLDR

The study used population‑based active laboratory surveillance across Alameda, Contra Costa, and San Francisco counties (population 2.94 million) and performed detailed chart review to assess the clinical significance of less common fungi. The cumulative incidence of invasive mycotic infections was 178.3 per million per year, with Candida, Cryptococcus, Coccidioides, Aspergillus, and Histoplasma accounting for the majority, while zygomycosis, hyalohyphomycosis, and phaeohyphomycosis had lower rates; HIV infection, non‑hematologic malignancy, diabetes, and chronic lung disease were the most common underlying conditions, marking the first population‑based epidemiologic assessment in the U.S.

Abstract

Population-based active laboratory surveillance for invasive mycotic infections was conducted during 1992 and 1993 in three California counties: Alameda, Contra Costa, and San Francisco (population, 2.94 million). The cumulative incidence of invasive mycotic infections was 178.3 per million per year. Invasive mycoses were most commonly caused by Candida (72.8 per million per year), Cryptococcus (65.5), Coccidioides (15.3), Aspergillus (12.4), and Histoplasma (7.1). The clinical significance of other, less common fungi was determined by detailed chart review. The cumulative incidence was determined for zygomycosis (1.7 per million per year), hyalohyphomycosis (1.2), and phaeohyphomycosis (1.0). The most common underlying conditions were human immunodeficiency virus infection (47.4%), nonhematologic malignancy (14.7%), diabetes mellitus (9.9%), and chronic lung disease (9.3%). This represents the first population-based epidemiological assessment of invasive mycoses in the United States.