Endemic areas:
(1) between 45 degrees North of the equator to 30 degrees South of the equator (North America, Central America, Europe, Asia)
(2) usually river valleys (Ohio and Mississippi valleys in the US)
(3) soil conditions that favor sporulation (moist, acidic)
High risk exposures:
(1) exploring caves
(2) other structures infested by bats
(3) cleaning chicken coops
(4) exposure to wild bird droppings, especially blackbirds (starlings, redwing blackbirds, etc.)
(5) cleaning, remodeling or demolishing old buildings
Patients at risk for disseminated disease:
(1) very young or very old
(2) HIV-infection, typically when the absolute CD4 count is < 100 per µL
(3) other patients with impaired cell-mediated immunity
