Systemic endemic mycoses: From a geographical risk to a concern expansion.

Blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, emergomycosis, and talaromycosis are sapronoses restricted to specific geographical areas associated with particular environmental niches that can lead to high morbidity and mortality if diagnosed or treated late. Challenges in clinical awareness arise from their nonspecific clinical presentations and the limited availability of sensitive diagnostic tools. Although advances in molecular diagnosis and antigen detection-based tests are promising, they are not available for all systemic endemic mycoses (SEM). Treatment guidelines emphasize the importance of early antifungal treatment, although only a few limited therapeutic options have remained available over the years. Most SEM are not notifiable diseases, resulting in underreporting and a poor understanding of their true burden. The inclusion of several SEM-causing dimorphic fungi in the WHO Fungal Priority Pathogens List highlights their growing public health impact, the lack of prevention methods, and unmet research needs. Recognizing SEM as neglected diseases, improving surveillance, expanding diagnostic access, and developing affordable vaccines and therapeutics are essential steps toward addressing this evolving global health challenge. Coordinated international efforts are urgently needed.