2407. Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients with Blastomycosis
Session: Poster Abstract Session: Transplantation Fungal Infections
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • clinicalmanifestationsblasto2017IDweekfinal.pdf (232.0 kB)
  • Background: Blastomyces dermatitidis and Blastomyces gilchristii are the etiologic agents of blastomycosis. Blastomyces is a human pathogenic fungi that infects both healthy and immunocompromised persons alike. Few studies have investigated blastomycosis in the immunocompromised. Moreover, no studies have compared immunocompromised to immunocompetent persons. The goal of this research is to delineate the clinical features and outcomes in patients with normal and impaired immune systems diagnosed with blastomycosis.

    Methods: A retrospective study of adult patients (>18 years) with culture-proven blastomycosis at the University of Wisconsin from 2004 - 2016 was performed with approval from the Institutional Review Board. Persons with solid organ transplantation (SOT), active malignancy, HIV/AIDS, or on pharmacologic immunosuppression at the time of diagnosis were classified as immunosuppressed. Opportunistic co-infections, duration of symptoms, anatomic site of infection (pulmonary versus disseminated disease), severity, and mortality were analyzed. Statistical analysis was performed by chi-square calculations.

    Results: 58 cases of in total were reviewed. 39 cases were classified as immunocompetent and 19 as immunocompromised (14 SOT, 2 on chronic steroids, 1 on chronic tacrolimus, 1 with active malignancy and 1 with AIDS). Immunocompetent hosts were more likely to have mild disease (p value = 0.032). Immunocompromised hosts were more likely to have acute infection (p value = 0.042). Immunocompromised hosts trended towards severe disease, respiratory failure, ARDS and decreased survival. Rates of dissemination was similar between populations. Co-infection with secondary opportunistic pathogens, such as CMV or BK virus, is seen in 35.7% of SOT recipients.

    Conclusion: Immunosuppression had implications on acuity, severity, and outcome of blastomycosis; however, rates of dissemination was similar between populations. SOT recipients with blastomycosis commonly have opportunistic co-infections.

    Joseph McBride, MD1,2, Alana Sterkel, PhD3, Eduard Matkovic, MD3 and Gregory Gauthier, MD2, (1)Pediatrics - Infectious Disease, University of Wisconsin, Madison, WI, (2)Medicine - Infectious Disease, University of Wisconsin, Madison, WI, (3)Pathology, University of Wisconsin Madison, Madison, WI

    Disclosures:

    J. McBride, None

    A. Sterkel, None

    E. Matkovic, None

    G. Gauthier, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.