Endemic Mycoses in 2026: can we keep the pace of redrawing maps?

PURPOSE OF REVIEW: The dimorphic fungal infections were classically grouped as endemic mycoses due to their restricted geographic distribution. However, their original geographic distribution dates from the twentieth century and true prevalence and distribution of these infections is limited by subclinical presentations, lack of healthcare provider awareness, lack of diagnostic capacity, and incomplete reporting. In this review, we discuss the new geographic distribution of endemic mycoses and the factors influencing its expansion.

RECENT FINDINGS: There has been an increase in incidence and reports of endemic mycoses diagnosed outside their classic geographic locations. Evidence shows expansion of the classic endemic areas and new areas of risk likely due to climate change, human mobility, and socioeconomic factors.

SUMMARY: Climate change, human mobility, socioeconomic disparities, and a growing immunosuppressed patient population affected the geographic distribution of dimorphic fungal infections and will challenge mycologist to keep up with the pace of redrawing the maps for these infections. There is a need for more research and public health initiatives in this field. Clinicians should have a high index of suspicion for dimorphic fungal infections, and all patients with compatible syndromes should receive appropriate testing, even in historically nonendemic areas.