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Blastomycosis in 64 Wisconsin Children: Unanticipated Infection Risk and Severity in Urban Residents
Jaimee M Hall1,2, Peter L Havens1, Errin A Mitchell1
1From the Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin.
Background:
Blastomycosis, an endemic mycosis of immunocompetent individuals, is typically seen after exposure to waterways within rural wooded regions. It is not considered a disease of urban environments. Infection can be solely pneumonic or disseminate to skin, bone or central nervous system. Unknown factors influence disease acquisition and severity in children.
Methods:
We analyzed acquisition risks and disease characteristics of blastomycosis in children seen at a tertiary care center from 1998 to 2018 to identify potential exposure sources, measure disease severity and assess the effect of race upon disease severity.
Results:
Of 64 infected children, mean age was 12.9 years, with median time to diagnosis 38.5 days. About 72% were male, 38% resided in urban counties and 50% had typical environmental exposure. Isolated pulmonary infection occurred in 33 (52%). The remainder had evidence of dissemination to skin (N = 13), bone (N = 16; 7 clinically silent) and cranium (N = 7; 3 clinically silent). Infection was moderate/severe in 19 (30%). Two children (3%) died. About 79% of children with moderate/severe disease (P = 0.008) and 71% of urban children (P = 0.007) lacked typical environmental exposure. Comparing children from urban counties to other residences, 63% versus 5% were black (P < 0.001) and 71% versus 35% developed extrapulmonary dissemination (P = 0.006). Moderate/severe disease was seen in 7/17 (42%) black children but only 12/47 (26%) children of other races (P = 0.23).
Conclusions:
Blastomycosis, can be endemic in urban children in the absence of typical exposure history, have frequent, sometimes clinically silent, extrapulmonary dissemination and possibly produces more severe disease in black children.
Insights
Blastomycosis (fungal infection) can occur in urban children without typical exposure. This infection frequently disseminates, sometimes silently, and may be more severe in Black children.
Area of Science:
- Medical Mycology
- Pediatric Infectious Diseases
- Epidemiology
Background:
- Blastomycosis is a fungal infection endemic to rural, wooded areas, typically affecting immunocompetent individuals.
- It is not traditionally considered an urban disease.
- Infections can be limited to the lungs or spread to skin, bone, or the central nervous system, with unknown factors influencing pediatric disease acquisition and severity.
Purpose of the Study:
- To analyze the risks of acquiring blastomycosis and its disease characteristics in children.
- To identify potential exposure sources in pediatric cases.
- To measure disease severity and assess the impact of race on blastomycosis severity in children.
Main Methods:
- Retrospective analysis of pediatric blastomycosis cases (1998-2018) at a tertiary care center.
- Evaluation of patient demographics, exposure history, clinical presentation, and disease dissemination.
- Assessment of disease severity and correlation with race and geographic residence (urban vs. rural).
Main Results:
- Of 64 children, 38% resided in urban counties; 50% had typical environmental exposure.
- Pulmonary infection occurred in 52%; dissemination to skin, bone, or cranium occurred in the remaining cases, with some instances being clinically silent.
- Urban and Black children were more likely to lack typical environmental exposure and experience extrapulmonary dissemination; Black children showed a trend towards more severe disease.
Conclusions:
- Blastomycosis can occur in urban children without a clear history of typical environmental exposure.
- Extrapulmonary dissemination, including clinically silent forms, is frequent in pediatric blastomycosis.
- Race may influence blastomycosis severity, with Black children potentially experiencing more severe outcomes.
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