Abstract
Blastomycosis, caused by the organism Blastomyces dermatitidis, is an invasive fungal disease found in Central Canada and Central and Midwestern United States. To describe trends in and epidemiology of hospitalized cases of blastomycosis cases reported among northwestern Ontario residents between 2006 and 2015. Blastomycosis hospitalization data were extracted from the Discharge Abstract Database (DAD), accessed through IntelliHEALTH Ontario. The DAD includes administrative, clinical and demographic information on hospital discharges provided by the Canadian Institute for Health Information (CIHI). Blastomycosis records were identified using ICD-10 codes B40.0 to B40.9. Hospitalization rates were calculated for all of Ontario, and age-specific hospitalization rates were calculated for northwestern Ontario and analyzed by local health region, time and seasonality as well as presenting symptoms. There were 581 hospitalizations for blastomycosis reported in Ontario over this 10-year period. Of these, 245 (42%) were from northwestern Ontario, although this region accounts for only 0.6% of the Ontario population. The average hospitalization rate for blastomycosis in northwestern Ontario was 35.0 per 100,000 per year. This rate varied from 1.7 in the Red Lake region to 57.9 in the Kenora region. The most common presentation was acute pulmonary symptoms. Men were 1.36 times more likely to be hospitalized for blastomycosis than were women (95% confidence interval [CI]: 1.06-1.75, P<0.05). Most hospitalizations were registered in the late fall months, suggesting blastomycosis exposure in the spring/summer season followed by a lengthy incubation period. Areas of northwestern Ontario have high reported rates of blastomycosis. It is not known to what extent there are regional differences in other states and provinces. Interregional differences may warrant prioritizing strategies for blastomycosis prevention and control as well as additional research and surveillance.
Highlights
Blastomycosis, caused by the organism Blastomyces dermatitidis, is an invasive fungal disease whose only known natural reservoir is in soil
Blastomycosis hospitalizations were lowest among children aged less than 10 years and adults aged 60 years and older
Examination of the data showed that overrepresentation of males inflated this overall estimate; the rate ratio among men aged 30–39 years was 2.51 compared with females in this age group, among whom rates were insignificant
Summary
Blastomycosis, caused by the organism Blastomyces dermatitidis, is an invasive fungal disease whose only known natural reservoir is in soil. Cases of blastomycosis have occurred mainly across the eastern areas of North America, in the provinces and states that border the Great Lakes (i.e., Ontario, Michigan, Wisconsin, Minnesota), but some have been found in the midwestern United States and central Canada [1]. It is estimated that 70% of cases can be attributed to pulmonary blastomycosis, which usually presents as flu-like illness; the symptoms may be commonly misdiagnosed as other morbidities, for example, tuberculosis. Extrapulmonary disease most commonly manifests as cutaneous blastomycosis, but it can occur in the skeletal, urogenital and central nervous systems. Blastomycosis, caused by the organism Blastomyces dermatitidis, is an invasive fungal disease found in Central Canada and Central and Midwestern United States
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