Histoplasmosis and paracoccidioidomycosis (PCM) have increased in Spain in recent years, due firstly to the migration from endemic regions and secondly to travelers returning from these regions. In non-endemic areas, selleck products diagnosis of both diseases is hampered by the lack of experience, long silent periods, and the resemblance to other diseases such as tuberculosis and sarcoidosis. Methods. A total of 39 cases of imported histoplasmosis and 6 cases of PCM diagnosed in the Spanish Mycology Reference Laboratory since 2006 were analyzed. Microbiological diagnosis was performed using classical methods and also a specific real-time polymerase chain reaction (RT-PCR) assay for each microorganism. Results. We

had 9 cases of probable histoplasmosis in travelers and 30 cases in immigrants, 29 of whom were defined as proven. Paracoccidioidomycosis (PCM) cases were either immigrants or people who had learn more lived for a long period of time in endemic regions, all of whom were classified

as proven cases. Cultures showed a good sensitivity in detecting Histoplasma capsulatum in immigrants with proven histoplasmosis (73%); however, growth was very slow. The fungus was never recovered in traveler patients. Paracoccidioides brasiliensis was isolated in a culture only in one case of the proven PCM. Serological methods were not very reliable in immunocompromized patients with histoplasmosis (40%). A PCR-based technique for histoplasmosis detected 55.5% of the cases in travelers (probable cases) and 89% of the cases

in immigrants (proven). The PCR method for PCM detected 100% of the cases. Conclusions. These kinds of mycoses are increasingly frequent in non-endemic areas, and newer and faster techniques should be used to reach an early diagnosis. The RT-PCR techniques developed appear to be sensitive, specific, and fast and could be helpful to detect those mycoses. However, it is also essential that physicians perform differential diagnosis in individuals coming from endemic areas. Endemic mycoses have risen in recent years in Spain due to both the increase in the immigrant population from endemic areas and travelers returning from these regions. At present, the immigrant population from South America constitutes 38% of the total (www.ine.es), and 1 million Spaniards visit tropical or equatorial areas every year. The number Megestrol Acetate of diagnosis requests for these mycoses in our laboratory has increased seven times in 10 years (data not shown). Histoplasmosis is the most frequently reported endemic mycosis in Europe.1 In Spain, several cases of histoplasmosis have been described in travelers returning from endemic areas.2–5 Most cases occur in small clusters with a common source of infection. The individuals affected have a history of involvement in leisure and/or work activities.2 In immunocompetent hosts, diagnosis of histoplasmosis is difficult because of its nonspecific clinical manifestations.