soil, hot summers and short, moist winters; it is endemic in parts of south-western USA, Mexico and Central and South America. People become infected when they inhale arthroconidia from soil. An unusual wind storm in 1977 lifted soil from the endemic region and deposited it in northern California, outside the usual endemic region.[@bb0030] In general, infection is associated with residence in or travel through the endemic region. However, because the fungus can persist in the human host for years, even decades, after initial infection (which may be mild and unrecognized), disease may be diagnosed far from the endemic regions. Although it is a 'place' disease, coccidioidomycosis has increased in the southwestern USA in recent years, in part attributable to a large influx of susceptible humans into the endemicor travel to areas where sanitary facilities were poor. In the summer of 1996, a large US outbreak occurred in persons who had not traveled. Over a period of a few months, 1465 cases of cyclosporiasis were reported from 20 states. The outbreak was linked to eating raspberries imported from Guatemala.[@bb0255] During some seasons of the year up to 70% of selected fruits and vegetables sold in the USA come from developing countries.

### Visceral leishmaniasis {#s0065}

In the past, visceral leishmaniasis in Brazil was primarily a rural disease. Recently, however, several cities have reported large outbreaks of visceral leishmaniasis.[@bb0260] Reasons for the change in epidemiology include geoclimatic and economic factors (drought, lack of farm land, famine), leading to migration of large numbers of persons, who settle in periurban areas