959. Morbidity and Mortality of Blastomycosis in Children
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • FINAL IDSA Poster Blastomycosis 10172011.pdf (387.4 kB)
  • Background: Blastomycosis (BLM) fungal infection is endemic in the Midwest and Southeastern US.  Infection begins in the respiratory tract with occasional dissemination to other organs such as the skin and bones.  Data regarding pediatric BLM are limited but suggest extra-pulmonary dissemination occurs in up to 80% of children. 

    Methods: We retrospectively reviewed BLM cases at Children’s Memorial Hospital over the past 24 years.  Cases were identified by ICD9 codes, infectious disease clinic and microbiology records.  Identified cases were reviewed to determine risk factors, clinical features, treatment, and outcomes.  Grubbs’ test was performed to identify outliers and unpaired t-testing was used to compare means with a two-tailed p-value.

    Results: 14 patients (pts) < 19 yrs of age were identified from 1987 –2011.  The median (med) age was 11.5 yrs [range (rg) of 4.8 – 18.7 yrs].  57% were female.  43% were black, 21% Hispanic, 14% white, and 14% Asian. None of the pts were immunocompromised; 21% had underlying cardiac disease. Symptoms included cough-79%, fever-71%, and weight loss-50%. Symptoms began a med of 60 days prior to diagnosis (rg 14 – 540 d).  WBC count was elevated in most (med 16.6, rg 8.6 – 30.4) and ESR was elevated in all 9 pts tested (med 67, rg 40 – 111). Pulmonary disease was identified in 86%. One additional pt had laryngeal BLM.  Extra-pulmonary dissemination occurred in 43% of pts, with skin or bone disease each occurring in 29%.  Complement fixation or immunodiffusion testing was positive in only 1/7 pts.  In contrast, urine BLM or histoplasmosis antigens were positive in all tested pts (3/3 and 4/4, respectively). 12/14 pts (86%) were hospitalized, 29% were admitted to intensive care, and 21% died.  4 pts were treated only with Itraconazole and none had toxicity whereas 7/9 pts treated with liposomal or deoxycholate amphotericin had nephrotoxicity (p = 0.02).  Excluding the laryngeal BLM pt, mortality tended to be associated with a delay from onset of symptoms to diagnosis (p = 0.08).

    Conclusion: BLM, and its treatment with amphotericin, was found to be responsible for significant pediatric morbidity. Extra-pulmonary dissemination occurred in 43% of pts and mortality tended to occur in pts with a delay between onset of symptoms and diagnosis. 


    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Paul Ahn, MD, Greater Roslindale Med/Dental Center,, Roslindale, MA, Evan Anderson, MD, Nortwestern University Feinberg School of Medicine, Chicago, IL; Children's Memorial Hospital and Northwestern Memorial Hospital, Chicago, IL, Preeti Jaggi, MD, Pediatrics, Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, Ram Yogev, MD, Children's Memorial Hospital, Chicago, IL and Stanford T. Shulman, MD, FIDSA, Children's Memorial Hospital Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL

    Disclosures:

    P. Ahn, None

    E. Anderson, Merck: Grant Investigator, Research grant
    Medscape: Independent Contractor,

    P. Jaggi, None

    R. Yogev, None

    S. T. Shulman, None

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