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Blastomycosis in indiana: digging up more cases
W Graham Carlos1, Anthony S Rose, L Joseph Wheat
1Pulmonary-Critical Care and Infectious Diseases, Roudebush VA Medical Center and Indiana University, Indianapolis, IN 46202, USA. chage@iupui.edu
Background:
The endemic region of blastomycosis historically has included the state of Indiana. However, few published reports of blastomycosis exist to substantiate this distinction. A surge of patients with blastomycosis in central Indiana (Indianapolis and surrounding counties) beginning in 2005 prompted us to review our local experience. We propose that this surge was related to major highway construction around Indianapolis.
Methods:
We reviewed all microbiologically confirmed cases from four hospitals serving central Indiana. Chart review was completed for adult patients, and data were collected on clinical presentations, methods of diagnosis, comorbidities, radiologic findings, treatment, and outcomes. We plotted patient residence addresses with sites of highway construction.
Results:
Fifty-nine patients were identified from laboratory results and physician referral. Interestingly, a surge of blastomycosis incidence occurred in 34 patients between 2005 and 2008 during which time major highway projects were under way around the Indianapolis metropolitan area. The majority of these patients presented acutely and with pulmonary involvement. Fungal culture and antigen testing were the most sensitive means to diagnosis. Antifungal therapy was highly effective.
Conclusions:
This urban outbreak of blastomycosis in Indianapolis should prompt clinicians to consider blastomycosis in this highly endemic area of histoplasmosis.
Insights
A surge in blastomycosis cases in central Indiana from 2005-2008 coincided with major highway construction. This suggests environmental factors, like construction, may increase exposure to this fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Epidemiology
Background:
- Blastomycosis is endemic to Indiana, but reports are scarce.
- A significant increase in blastomycosis cases was observed in central Indiana starting in 2005.
- This surge prompted an investigation into local case data.
Purpose of the Study:
- To review local blastomycosis cases in central Indiana.
- To investigate a potential link between a blastomycosis surge and highway construction.
- To understand the clinical presentation and diagnosis of blastomycosis in the region.
Main Methods:
- Retrospective review of microbiologically confirmed blastomycosis cases from four central Indiana hospitals.
- Data collection included clinical presentation, diagnosis methods, comorbidities, imaging, treatment, and outcomes.
- Patient addresses were mapped against highway construction sites.
Main Results:
- Fifty-nine cases were identified; 34 occurred between 2005 and 2008 during major highway construction in Indianapolis.
- Most patients presented with acute pulmonary blastomycosis.
- Fungal culture and antigen testing were sensitive diagnostic methods; antifungal therapy was effective.
Conclusions:
- An urban outbreak of blastomycosis occurred in Indianapolis, potentially linked to environmental factors from construction.
- Clinicians in this endemic region should consider blastomycosis, especially given potential environmental triggers.
- This highlights the importance of recognizing blastomycosis in areas also endemic for histoplasmosis.
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