- Mississippi & Ohio river valley
- Exposure to bird or bat droppings→ chicken coops/caves
- HIV+, otherwise immunocomp
- Can be asx/mild and resolve spont; often see x-ray evidence prior infection lung, spleen w/o known past infxn
- Tends to cause resp/systemic illness, oral ulcers in HIV+ or immunocomp
- Normal hosts usually dont have manifestations
- HIV + can affect most organ systems: oral ulcers, hepatomegaly, splenomegaly, skin, adenopathy, focal lung findings, other