Methods: All culture confirmed or histopathologically identified cases of blastomycosis from VUMC between 2002 to 2014 were reviewed retrospectively. Data relating to comorbid conditions, IS state, infection severity, hospitalizations, and outcomes were collected. Standardized definitions from blastomycosis clinical guidelines were used to code for disseminated disease (DD). New diagnoses at VUMC after the May 2010 Cumberland River flood were geospatially plotted by zip code against rainfall totals.
Results: 96 cases were identified. 29 (30.2%) were identified by culture 32 (33.3%) by histopathology, and 35 (36.5%) by both methods. Mean age was 44.8 years. Of total cases, 33% (n =32) were IS predominantly due to solid tumor malignancy (n =11; 11.5%). 52.1% presented with localized pulmonary disease. 46 individuals developed DD, most commonly involving the skin (26/46; 56.5%). 10.4% of patients presented with ARDS. Total mortality was 9.3%; 66.7% of total mortality was found in the setting of ARDS. Itraconazole was the most common treatment (n =68; 70.8%) with a mean duration of therapy of 212.3 days. By univariate analysis, IS was associated with increased likelihood for hospitalization (OR= 2.4; p = .043; CI 1.02– 5.51). IS individuals were less likely to have DD (OR .26; p =.003; CI .10 - .64) and were more likely to require supplementary O2 (OR = 5.1; p = .004; CI 1.69 -15.2). Those with DD were less likely to develop ARDS (OR =.18; p =.042; CI .037-.94). No correlation was found between cases presenting from areas with high rainfall totals and mortality, DD, or respiratory failure/ARDS.
Conclusion: Blastomycosis infections are rarely diagnosed but occur among IC and IS populations. Disseminated cutaneous disease is common among IC populations. IS individuals are more likely to require hospitalization. While there is no evidence of flooding affecting severity of disease presentation, further research is needed to determine whether flooding is a risk factor for infection.
C. Perez, None
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