Blastomycosis in 64 Wisconsin Children: Unanticipated Infection Risk and Severity in Urban Residents

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.