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.
E. Matkovic, None
G. Gauthier, None