Distribution of<unk>  in North America based on the map given by Kwon-Chung and Bennett, with modifications made according to case reports from a series of additional sources. Incidences in most endemic areas are circa 0.5 per 100,000 population, with occasional local areas attaining as high as 12 per 100,000. Most Canadian data fit this picture. In Ontario, Canada, considering both endemic and non-endemic areas, the overall incidence is around 0.3 cases per 100,000; northern Ontario, mostly endemic, has 2.44 per 100,000. Manitoba is calculated at 0.62 cases per 100,000. Remarkably higher incidences were shown for the Kenora, Ontario region: 117 per 100,000 overall, with aboriginal reserve communities experiencing 404.9 per 100,000. In the United States, the incidence of<unk>  is similarly high in hyperendemic areas. For example, the city of Eagle River, Vilas County, Wisconsin, which has an incidence rate of 101.3 per 100,000; the county as a whole has been shown in two successive studies to have an incidence of ca. 40 cases per 100,000. An incidence of 277 per 100,000 was roughly calculated based on 9 cases seen in a Wisconsin aboriginal reservation during a time in which extensive excavation was done for new housing construction. The new case rates are greater in northern states such as Wisconsin, where from 1986 to 1995 there were 1.4 cases per 100,000 people. The study of outbreaks as well as trends in individual cases of<unk>  has clarified a number of important matters. Some of these relate to the ongoing effort to understand the source of infectious inoculum of this species, while others relate to which groups of people are especially likely to become infected. Human<unk>  is primarily associated with forested areas and open watersheds; It primarily affects otherwise healthy, vigorous people, mostly middle-aged, who acquire the disease while working or undertaking recreational activities in sites conventionally considered clean, healthy and in many cases beautiful. Repeatedly associated activities include hunting, especially raccoon hunting, where accompanying dogs also tend to be affected, as well as working with wood or plant material in forested or riparian areas, involvement in forestry in highly endemic areas, excavation, fishing and possibly gardening and trapping. Urban infections There is also a developing profile of urban and other domestic<unk>  cases, beginning with an outbreak tentatively attributed to construction dust in Westmont, Illinois. The city of Rockford, Illinois, was also documented as a hyperendemic area based on incidence rates as high as 6.67 per 100,000 population for some areas of the city. Though proximity to open watersheds was linked to incidence in some areas, suggesting that outdoor activity within the city may be connected to many cases, there is also an increasing body of evidence that even the interiors of buildings may be risk areas. An early case concerned a prisoner who was confined to prison during the whole of his likely blastomycotic incubation period. An epidemiological survey found that although many patients who contracted<unk>  had engaged in fishing, hunting, gardening, outdoor work and excavation, the most strongly linked association in patients was living or visiting near waterways. Based on a similar finding in a Louisiana study, it has been suggested that place of residence might be the most important single factor in<unk>  epidemiology in north central Wisconsin. Follow-up epidemiological and case studies indicated that clusters of cases were often associated with particular domiciles, often spread out over a period of years, and that there were uncommon but regularly occurring cases in which pets kept mostly or entirely indoors, in particular cats, contracted<unk> . The occurrence of<unk> , then, is an issue strongly linked to housing and domestic circumstances. Seasonal trends Seasonality and weather also appear to be linked to contraction of<unk> . Many studies have suggested an association between<unk>  contraction and cool to moderately warm, moist periods of the spring and autumn or, in relatively warm winter areas. However, the entire summer or a known summer exposure date is included in the association in some studies. Occasional studies fail to detect a seasonal link. In terms of weather, both unusually dry weather and unusually moist weather have been cited. The seemingly contradictory data can most likely be reconciled by proposing that B. dermatitidis prospers in its natural habitats in times of moisture and moderate warmth, but that inoculum formed during these periods remains alive for some time and can be released into the air by subsequent dust formation under dry conditions. Indeed, dust per se or construction potentially linked to dust has been associated with several outbreaks The data, then, tend to link<unk>  to all weather, climate and atmospheric conditions except freezing weather, periods of snow cover, and extended periods of hot, dry summer weather in which soil is not agitated. Gender bias Sex is another factor inconstantly linked to contraction of<unk> : though many studies show more men than women affected, some show no sex-related bias. As mentioned above, most cases are in middle aged adults, but all age groups are affected, and cases in children are not uncommon. Ethnic populations Ethnic group or race is frequently investigated in epidemiological studies of<unk> , but is potentially profoundly conflicted by differences in residence and in quality and accessibility of medical care, factors that have not been stringently controlled for to date. In the USA, a disproportionately high incidence and/or mortality rate is occasionally shown for blacks; whereas aboriginals in Canada are disproportionately linked to<unk>  in some studies but not others. Incidence in aboriginal children may be unusually high. The Canadian data in some areas may be confounded or explained by the tendency to establish aboriginal communities in wooded, riparian, northern areas corresponding to the core habitat of B. dermatitidis, often with known B. dermatitidis habitats such as woodpiles and beaver constructions in the near vicinity. Communicability There are a very small number of cases of human-to-human transmission of B. dermatitidis related to dermal contact or sexual transmission of disseminated<unk>  of the genital tract among spouses.
Blastomycosis
Chromoblastomycosis
Actinomycosis
Basidiobolomycosis
Botryomycosis
Conidiobolomycosis
Talaromycosis
Dermatomycosis