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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
Chest
|June 19, 2010
Summary
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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