Table 2.

Endemic regions, natural habitats, and risk factors of exposure to endemic mycoses.

	Main endemic regions	Other areas	Natural habitat	Human activities/conditions associated with increased risk of exposure	Occupations associated with increased risk of exposure
Coccidioidomycosis	Arizona and California in the US	Other parts of Southwestern US: New Mexico, Nevada, Utah and Texas Central America: Mexico, Guatemala, HondurasSouth America: Venezuela, Brazil, Argentina, Paraguay	Alkaline soils in dry desert climates	Soil excavations Dust storms, earthquakes	Construction site workers, farmers, military personnel, excavators, archeologists, inmates, and officers in correctional facilities
Histoplasmosis	Histoplasma capsulatum var. capsulatum: Ohio and Mississippi River Valleys in the Upper Midwest and Southeastern US H. capsulatum var. duboisii (African histoplasmosis): between 20° North and 20° South of the equator, and Madagascar	Southern Mexico Central and South America, e.g., Brazil, Uruguay, Paraguay, Argentina, Venezuela Mainland China: provinces along the Yangtze River (Yunnan, Sichuan, Hubei, Hunan, Jiangsu, Zhejiang) Southeast Asia, e.g., Thailand India, especially West Bengal and Uttar Pradesh along the Gangetic plains Europe: Italy (Po River Valley), Spain, Germany	Soil contaminated by bird and chicken excreta, or bat guano; bat caves	Walking on contaminated grounds, setting up tents Excavation, clearing foliage in a bird-roosting site	Miners, cave explorers, guano workers, farmers, beekeepers, archeologists
Paracoccidioidomycosis	Paracoccidioides brasiliensis: Brazil, Columbia, Venezuela, Paraguay P. lutzii: Center-West of Brazil	Central America and Mexico	Acid soils in area of coffee and sugar cane plantations	Soil exposure	Farmers, outdoor workers Women are less likely to develop clinical disease as estrogens inhibit conidial transformation to yeast cells
Blastomycosis	US: Mississippi and Ohio River valleys, Midwestern states Canada: provinces that border the Great Lakes and the Saint Lawrence Riverway, including Manitoba and northwestern Ontario	Middle and East Africa India	Warm, moist soil with high organic content, e.g., animal droppings	Occupational, residential, or recreational exposures to wildlife, soil, or bodies of freshwater	Occupational, residential, or recreational exposures that occur in close proximity to bodies of freshwater
Talaromyces marneffei infection	Thailand, Vietnam, Southern China	Laos, Malaysia, Myanmar, Cambodia, Hong Kong, Taiwan, Northeastern India	Soil, particularly burrows of bamboo rats	Soil exposure during rainy season	Agricultural workers
Sporotrichosis	Peru, Brazil, Mexico (Jalisco and Puebla mountain ranges)	Worldwide distribution in temperate and tropical regions—US, Asia (China, India, Japan), Australia	Soil and decaying vegetation, e.g., dead wood, sphagnum moss, cornstalks, hay	Cutaneous trauma with wound contamination by plants or soil; contact with reeds after flooding, bites from mice, armadillos, squirrels, cats, and dogs	Farming, gardening, flower vending, handling hay, animal husbandry, armadillo hunting (in Uruguay), mining