Where is histoplasmosis endemic?

Histoplasmosis is caused by Histoplasma capsulatum, an environmental saprophyte. It is endemic in the midwestern and south central United States, where 80% of the population is skin test–positive. It does occur in other parts of the world, but it is not found in Europe. Soil infected with excreta from chickens, pigeons, blackbirds, and bats is inhaled, leading to a pulmonary infection. Rarely, primary cutaneous disease is contracted from traumatic inoculation.

Wheat LJ, Kauffman CA: Histoplasmosis, Infect Dis Clin North Am 17:1–19, 2003.