title: Blastomycosis in Children: An Analysis of Clinical, Epidemiologic, and Genetic Features.
abstract: BACKGROUND
  Blastomyces spp. are endemic in regions of the United States and result in blastomycosis, a serious and potentially fatal infection. Little is known about the presentation, clinic course, epidemiology, and genetics of blastomycosis in children.
  
  
  METHODS
  A retrospective review of children with blastomycosis confirmed by culture or cytopathology between 1999 and 2014 was completed. Blastomyces sp. isolates were genotyped by using microsatellite typing, and species were typed by sequencing of internal transcribed spacer 2 (its2).
  
  
  RESULTS
  Of the 114 children with blastomycosis identified, 79% had isolated pulmonary involvement and 21% had extrapulmonary disease. There were more systemic findings, including fever (P = .01), poor intake (P = .01), elevated white blood cell count (P < .01), and elevated C-reactive protein level (P < .01), in children with isolated pulmonary disease than in children with extrapulmonary disease. Children with extrapulmonary disease had more surgeries (P = .01) and delays in diagnosis (P < .01) than those with isolated pulmonary infection. Of 52 samples genotyped, 48 (92%) were Blastomyces gilchristii and 4 (8%) were Blastomyces dermatitidis.
  
  
  CONCLUSIONS
  This is the first large-scale study of the clinical, epidemiologic, and genetic features of blastomycosis in children. The majority of the children had isolated pulmonary disease with systemic findings. Patients with extrapulmonary disease were less likely to have systemic symptoms or additional laboratory evidence of infection, which made delays in diagnosis more common. More than 90% of the pediatric cases were caused by B gilchristii.
authors.affiliation: Department of Pediatrics, Marshfield Clinic, Minocqua.|Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Frost
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors.forename: Lynn
authors.initials: L
authors.lastname: Ivacic
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meece
mesh_terms: D000293:Adolescent; D001758:Blastomyces / Q000235:genetics*; D001759:Blastomycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000601:surgery; D002648:Child; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies
keywords: Blastomyces dermatitidis; Blastomyces gilchristii; blastomycosis; children; genotype