title: Variation in clinical phenotype of human infection among genetic groups of Blastomyces dermatitidis.
abstract: BACKGROUND
  Blastomyces dermatitidis, the etiologic agent of blastomycosis, has 2 genetic groups and shows varied clinical presentation, ranging from silent infections to fulminant respiratory disease and dissemination. The objective of this study was to determine whether clinical phenotype and outcomes vary based on the infecting organism's genetic group.
  
  
  METHODS
  We used microsatellites to genotype 227 clinical isolates of B. dermatitidis from Wisconsin patients. For each isolate, corresponding clinical disease characteristics and patient demographic information were abstracted from electronic health records and Wisconsin Division of Health reportable disease forms and questionnaires.
  
  
  RESULTS
  In univariate analysis, group 1 isolates were more likely to be associated with pulmonary-only infections (P < .0001) and constitutional symptoms such as fever (P < .0001). In contrast, group 2 isolates were more likely to be associated with disseminated disease (P < .0001), older patient age (P < .0001), and comorbidities (P = .0019). In multivariate analysis, disease onset to diagnosis of >1 month (P < .0001), older age at diagnosis (P < .0001), and current smoking status (P = .0001) remained predictors for group 2 infections.
  
  
  CONCLUSIONS
  This study identified previously unknown associations between clinical phenotype of human infection and genetic groups of B. dermatitidis and provides a framework for further investigations of the genetic basis for virulence in B. dermatitidis.
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wisconsin 54449, USA. meece.jennifer@mcrf.mfldclin.edu
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Meece
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Sarah
authors.initials: S
authors.lastname: Gruszka
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sloss
authors.forename: Bradley
authors.initials: B
authors.lastname: Sullivan
authors.forename: Kurt D
authors.initials: KD
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001758:Blastomyces / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D001759:Blastomycosis / Q000382:microbiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D018895:Microsatellite Repeats; D008875:Middle Aged; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D010641:Phenotype; D011795:Surveys and Questionnaires; D014922:Wisconsin; D055815:Young Adult