Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 4;72(9):1594-1602.
doi: 10.1093/cid/ciaa276.

Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients With Blastomycosis

Joseph A McBride  1   2 , Alana K Sterkel  3   4 , Eduard Matkovic  3 , Aimee T Broman  5 , Suzanne N Gibbons-Burgener  6 , Gregory M Gauthier  1
Affiliations

Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients With Blastomycosis

Joseph A McBride et al. Clin Infect Dis. .

Abstract

Background: Blastomyces is a dimorphic fungus that infects persons with or without underlying immunocompromise. To date, no study has compared the clinical features and outcomes of blastomycosis between immunocompromised and immunocompetent persons.

Methods: A retrospective study of adult patients with proven blastomycosis from 2004-2016 was conducted at the University of Wisconsin. Epidemiology, clinical features, and outcomes were analyzed among solid-organ transplantation (SOT) recipients, persons with non-SOT immunocompromise (non-SOT IC), and persons with no immunocompromise (NIC).

Results: A total of 106 cases met the inclusion criteria including 74 NIC, 19 SOT, and 13 non-SOT IC (malignancy, HIV/AIDS, idiopathic CD4+ lymphopenia). The majority of patients (61.3%) had at least 1 epidemiologic risk factor for acquisition of Blastomyces. Pneumonia was the most common manifestation in all groups; however, immunocompromised patients had higher rates of acute pulmonary disease (P = .03), more severe infection (P = .007), respiratory failure (P = .010), and increased mortality (P = .02). Receipt of SOT primarily accounted for increased severity, respiratory failure, and mortality in immunosuppressed patients. SOT recipients had an 18-fold higher annual incidence of blastomycosis than the general population. The rate of disseminated blastomycosis was similar among NIC, SOT, and non-SOT IC. Relapse rates were low (5.3-7.7%).

Conclusions: Immunosuppression had implications regarding the acuity, severity, and respiratory failure. The rate of dissemination was similar across the immunologic spectrum, which is in sharp contrast to other endemic fungi. This suggests that pathogen-related factors have a greater influence on dissemination for blastomycosis than immune defense.

Keywords: Blastomyces; blastomycosis; immunocompromise; solid-organ transplantation.

PubMed Disclaimer

References

    1. McBride JA, Gauthier GM, Klein BS. Clinical manifestations and treatment of Blastomycosis. Clin Chest Med 2017; 38:435–49. - PMC - PubMed
    1. Maphanga TG, Birkhead M, Muñoz JF, et al. . Human Blastomycosis in South Africa caused by Blastomyces percursus and Blastomyces emzantsi sp. nov., 1967–2014. J Clin Microbiol 2020. Epub ahead of print. doi:10.1128/JCM.01661-19 - DOI - PMC - PubMed
    1. Frost HM, Anderson JL, Ivacic L, Sloss BL, Embil J, Meece JK. Development and validation of a novel single nucleotide polymorphism (SNP) panel for genetic analysis of Blastomyces spp. and association analysis. BMC Infect Dis 2016; 16:509. - PMC - PubMed
    1. Meece JK, Anderson JL, Gruszka S, Sloss BL, Sullivan B, Reed KD. Variation in clinical phenotype of human infection among genetic groups of Blastomyces dermatitidis. J Infect Dis 2013; 207:814–22. - PubMed
    1. Nemecek JC, Wüthrich M, Klein BS. Global control of dimorphism and virulence in fungi. Science 2006; 312:583–8. - PubMed

Publication types

Substances