I have spent the better part of three decades watching the same story repeat itself in different geographies, different languages, and with different pathogens. The disease changes. The communities bearing the brunt of it rarely do.
The current histoplasmosis cluster in middle Tennessee, at least 36 cases including severe infections and at least one confirmed death across Williamson and Maury counties as of early 2026, is being covered as a public health curiosity. A fungal outbreak. An investigation still in progress. What it should also be covered as is the story about who gets heard when they say they are sick, and what happens when they are not.
Histoplasma capsulatum lives in soil, particularly soil contaminated with bird or bat droppings. When that soil is disturbed, spores become airborne. Construction activity has been identified as a factor investigators are examining in the Tennessee cluster, where multiple affected families live near active development. The residents breathing that air are not construction workers. They are families. Children. A 14-year-old who spent months running a fever before anyone found the answer. A young woman named Alyssia Brown, whose test results came back positive for histoplasmosis three days after she died.
That last detail is one that should stop us.
Histoplasmosis presents like influenza: fever, cough, fatigue, chest pain. It mimics pneumonia, and in some cases tuberculosis. For a patient with health insurance, a primary care relationship and a physician who thinks to test for a fungal infection endemic to the region, the diagnostic window is frustrating but survivable. For a patient who has to wait hours in an emergency room and whose family has to beg repeatedly for a specific test, exactly what Alyssia Brown’s loved ones described, that window closes faster than it should.