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Blastomycosis in 64 Wisconsin Children: Unanticipated Infection Risk and Severity in Urban Residents. Pediatr Infect Dis J 2021 09 01;40(9):802-807



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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.

Author List

Hall JM, Havens PL, Mitchell EA, De Vela GN, Titus LL, Dasgupta M, Simpson PM, Kehl SC, Willoughby RE, Henrickson KJ, Mitchell ML, Huppler AR, Chusid MJ


Kelly J. Henrickson MD Professor in the Pediatrics department at Medical College of Wisconsin
Anna H. Huppler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Michelle Mitchell MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Lauren Titus MD Adjunct Instructor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

African Americans
Child, Preschool
Infant, Newborn
Patient Acuity
Retrospective Studies
Risk Factors
Tertiary Care Centers
Urban Population