Panicle and shoot blight of pistachio caused by species of Botryosphaeriaceae fungi remains one of the major diseases of pistachio in California, with the highest potential for crop destruction because buds and fruit clusters (panicles) are killed. Pistachio fruit can also be damaged by various insect pests. For instance, hemipteran insects are considered major pests of pistachio and can attack maturing fruit, causing necrotic areas on the fruit epicarp (epicarp lesion). Surveys in pistachio orchards showed a putative association of punctures of pistachio fruit with infection by Botryosphaeriaceae fungi, resulting in panicle and shoot blight. This study was undertaken to determine any association of Botryosphaeriaceae fungi with fruit bearing epicarp lesions and whether hemipteran insects can actively carry propagules of the pathogens to healthy fruit and cause disease. Three large insects of the order Hemiptera (Thyanta pallidovirens, Acrosternum hilare, and Leptoglossus clypealis) were used in pathogen-spread and infection experiments. The most frequently isolated species of the family Botryosphaeriaceae in pistachio, Neofusicoccum mediterraneum, was used in these transmission experiments. Significantly higher incidence of fruit infected by N. mediterraneum was recorded when pistachio clusters were sprayed with a spore suspension of N. mediterraneum and caged with the above insects than the level of infected fruit sprayed similarly with the pathogen but caged without any insects. Furthermore, increasing the number of insects caged with pistachio clusters resulted in an increase of insect feeding punctures and, subsequently, disease incidence. Similarly, increasing the number of wounds per fruit made with a needle, simulating injuries caused by the insect’s stylet, resulted in significantly higher incidence of infected fruit than for wounded fruit with fewer injured sites. In addition, bird-injured fruit were also associated with higher incidence of panicle blight than fruit not injured by birds, especially in orchards with high disease incidence. In laboratory experiments, wounding or applying fruit sap to nonwounded fruit resulted in significantly higher incidence of infected fruit than in nonwounded fruit without sap. In field experiments, wounding of fruit before or after inoculation with N. mediterraneum resulted in higher disease incidence than nonwounded and inoculated fruit. Additionally, fruit sap enhanced initial mycelial growth of N. mediterraneum. Protecting fruit clusters from injuries by hemipteran insects or birds using mesh cages significantly reduced the incidence of panicle and shoot blight. The association of wounding by hemipteran insects and birds with high incidence of infected pistachio fruit may explain partially the broad distribution of Botryosphaeria panicle and shoot blight among pistachio orchards of the central San Joaquin Valley, even in areas where inoculum sources are not nearby.