Fungal infections, invasive Haemophilus influenza and legionellosis are on the rise in the United States, according to the CDC.

Older adults in the midwestern and western parts of the country appear to be at highest risk for histoplasmosis, coccidioidomycosis and blastomycosis. Histoplasmosis was the most common endemic mycosis identified.

Histoplasmosis and blastomycosis incidence were highest in the Midwest, and coccidioidomycosis incidence rate was highest in the West. COPD was the most common underlying disease for each endemic mycosis.

“[Clinicians] in these areas should consider fungal infections in older patients with respiratory disease,” advised the CDC (Emerg Infect Dis. 2011;17:1664-1669).

The same journal issue included a study on invasive disease caused by H. influenzae among Utah adults during 1998-2008 (Emerg Infect Dis. 2011;17:1645-1650). Although a vaccine has made H. influenzae type b (HiB) almost nonexistent in children, the incidence of invasive H. influenzae appears to be increasing among Utah adults, particularly those aged 65 years and older. This increase is mostly due to the rising incidence of nontypeable H. influenzae and H. influenzae type f. The case-fatality rate was 22%.

Finally, the CDC announced that the number of U.S. legionellosis cases increased by 217% from 2000 to 2009, from 1,110 to 3,522 (MMWR. 2011;60;1083-1086). The most common forms of legionellosis are Legionnaires disease and Pontiac fever.

The FDA now requires all tumor necrosis factor-alpha blockers to carry updated Boxed Warnings that include the risk of infection from Legionella as well as Listeria.