title: Blastomycosis in children and adolescents: a 30-year experience from Manitoba.
abstract: Blastomyces dermatitidis, a thermally dimorphic fungus endemic to areas of North America, causes a granulomatous infection which may affect any organ system. Since limited clinical data exist about pediatric blastomycosis, we conducted a retrospective review of medical records of pediatric patients with a laboratory-confirmed diagnosis of blastomycosis treated during a 30-year period at a tertiary care center. Thirty-four pediatric patients with blastomycosis were identified (20 [59%] male), with a mean age at diagnosis of 10 ± 5 years. Two patients were immunocompromised. Pulmonary disease was noted in 27 (79%) patients, and extrapulmonary disease was found in 13 (38%) patients (concurrent pulmonary and extrapulmonary disease, six patients), including five cases of central nervous system (CNS) disease. Delay in diagnosis was greater with extrapulmonary or central nervous system infections as compared with pulmonary blastomycosis. All patients received antifungal chemotherapy, with 19 (56%) patients receiving amphotericin B as initial therapy for 27.5 ± 17 days. Five patients required treatment in the intensive care unit. One patient died of non-Hodgkins lymphoma. Blastomycosis may occur in healthy children, including very young infants. Due to the frequency of extra-pulmonary disease, diagnosis may be difficult and frequently delayed, especially in cases of CNS infection.
authors.affiliation: Section of Infectious Disease, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada. umfanell@cc.umanitoba.ca
authors.forename: Sergio
authors.initials: S
authors.lastname: Fanella
authors.forename: Stuart
authors.initials: S
authors.lastname: Skinner
authors.forename: Elly
authors.initials: E
authors.lastname: Trepman
authors.forename: John M
authors.initials: JM
authors.lastname: Embil
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001758:Blastomyces / Q000302:isolation & purification*; D001759:Blastomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B