Methods: A retrospective chart review of children with confirmed blastomycosis from 1999-2014 was completed and state epidemiologic data from this time period were analyzed. Blastomyces isolates from children were genotyped using microsatellite typing and species typed by sequencing of the internal transcribed spacer 2 (its2).
Results: A total of 114 children with confirmed blastomycosis were identified; 79% of children had isolated pulmonary involvement and 21% had extra pulmonary disease. Children with isolated pulmonary disease had increased systemic findings including fever (p=0.01), poor oral intake (p=0.01), elevated WBC (p<0.01), and elevated CRP (p<0.01). Children with extra pulmonary disease had increased need for surgery (p=0.01) and delays in diagnosis (p<0.01). Of 52 samples genotyped, 48 (92%) children had B. gilchristii infections, which differs significantly from adults. Microsatellite group assignment and its2 species sequencing showed completed correlation with Group1 being equivalent to B. gilchristii and Group 2 equivalent to B. dermatitidis. .
Conclusion: This is the first large scale study of the clinical, epidemiologic, and genetic features of blastomycosis in children. The majority of children had isolated pulmonary disease with systemic findings. Patients with extra pulmonary disease were less likely to have systemic symptoms or additional laboratory evidence of infection making delays in diagnosis more common. Over 90% of pediatric cases were caused by B. gilchristii.
J. Anderson, None
L. Ivacic, None