Abstract
Introduction
Blastomycosis is an uncommon; potentially life-threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients admitted with blastomycosis.
Methods
All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.
Results
A total of 84 Patients were identified with 90 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1–65, range: 6–85) years and 56 (66.7%) were male. The most frequent comorbidities included hypertension (n = 28, 33.3%); immunosuppressed state (n = 25, 29.8%), and diabetes mellitus (n = 21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases.
A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (n = 20, 23.8%), acute respiratory distress syndrome (ARDS) (n = 13, 15.5%), tracheostomy (n = 9, 10.7%), renal replacement therapy (n = 8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (n = 4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (P = 0.0255).
Conclusion
Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. RRT was associated with in-hospital mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ARDS:
-
Acute respiratory distress syndrome
- BAL:
-
Bronchoalveolar lavage
- COPD:
-
Chronic obstructive pulmonary disease
- CNS:
-
Central nervous system
- ECMO:
-
Extracorporeal membrane oxygenation
- ESRD:
-
End stage renal disease
- HSCT:
-
Hematopoietic stem cell transplant
- IBD:
-
Inflammatory bowel disease
- ICU:
-
Intensive care unit
- ILD:
-
Interstitial lung disease
- RRT:
-
Renal replacement therapy
References
Brown EM et al (2018) Epidemiology and geographic distribution of blastomycosis, histoplasmosis, and coccidioidomycosis, Ontario, Canada, 1990–2015. Emerg Infect Dis 24(7):1257–1266
Benedict K et al (2012) Epidemiologic and Ecologic Features of Blastomycosis: A Review. Current Fungal Infection Reports 6(4):327–335
Reed KD et al (2008) Ecologic niche modeling of blastomyces dermatitidis in Wisconsin. PLoS ONE 3(4):e2034
Morris SK et al (2006) Blastomycosis in Ontario, 1994–2003. Emerg Infect Dis 12(2):274–279
Pfister JR et al (2011) Non-rural point source blastomycosis outbreak near a yard waste collection site. Clin Med Res 9(2):57–65
Roy M et al (2013) A large community outbreak of blastomycosis in Wisconsin with geographic and ethnic clustering. Clin Infect Dis 57(5):655–662
Smith JA, Kauffman CA (2010) Blastomycosis. Proc Am Thorac Soc 7(3):173–180
Chapman SW et al (1997) Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect 12(3):219–228
Pappas PG et al (1993) Blastomycosis in immunocompromised patients. Medicine (Baltimore) 72(5):311–325
Recht LD et al (1982) Blastomycosis in immunosuppressed patients. Am Rev Respir Dis 125(3):359–362
Serody JS et al (1993) Blastomycosis in transplant recipients: report of a case and review. Clin Infect Dis 16(1):54–58
Schwartz IS et al (2016) Management and outcomes of acute respiratory distress syndrome caused by blastomycosis: a retrospective case series. Medicine (Baltimore) 95(18):e3538
Azar MM et al (2015) Blastomycosis in Indiana: clinical and epidemiologic patterns of disease gleaned from a multicenter retrospective study. Chest 148(5):1276–1284
Ranieri VM et al (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307(23):2526–2533
Kralt D et al (2009) Clinical characteristics and outcomes in patients with pulmonary blastomycosis. Mycopathologia 167(3):115–124
Ireland M et al (2020) Blastomycosis in Minnesota, USA, 1999–2018. Emerg Infect Dis 26(5):866–875
Rush B et al (2020) Outcomes with severe blastomycosis and respiratory failure in the United States. Clin Infect Dis 72(9):1603–1607
Bellani G et al (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315(8):788–800
McBride JA et al (2021) Clinical manifestations and outcomes in immunocompetent and immunocompromised patients with blastomycosis. Clin Infect Dis 72(9):1594–1602
Funding
The authors have no funding sources to report.
Author information
Authors and Affiliations
Contributions
Conception and design: YA, AA, HA, SP, RT, BP, PJ, VI; Analysis and interpretation: YA, AA, HA, VA, VI; Drafting the manuscript for important intellectual content: YA, AA, HA, VA, HJ, VI.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ahluwalia, V., Almodallal, Y., Alkurashi, A.K. et al. Intensive Care Unit and Hospital Outcomes of Patients Admitted with Blastomycosis: A 14-Year Retrospective Study. Lung 200, 129–135 (2022). https://doi.org/10.1007/s00408-021-00499-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-021-00499-7