Abstract
Purpose
The diagnosis of pulmonary blastomycosis is usually delayed because of its non-specific presentation. We aimed to assess the extent of diagnostic delay in hospitalized patients and detect the step in the diagnostic process that requires the most improvement.
Methods
Adult patients diagnosed with pulmonary blastomycosis during a hospital admission between January 2010 through November 2021 were eligible for inclusion. Patients who did not have pulmonary involvement and who were diagnosed before admission were excluded. Demographics and comorbid conditions, specifics of disease presentation, and interventions were evaluated. The timing of the diagnosis, antifungal treatment, and patient outcomes were noted. Descriptive analytical tests were performed.
Results
A total of 43 patients were diagnosed with pulmonary blastomycosis during their admissions. The median age was 47 years, with 13 (30%) females. Of all patients, 29 (67%) had isolated pulmonary infection, while 14 (33%) had disseminated disease, affecting mostly skin and musculoskeletal system. The median duration between the initial symptoms and health care encounters was 4 days, and the time to hospital admission was 9 days. The median duration from the initial symptoms to the diagnosis was 20 days. Forty patients (93%) were treated with empirical antibacterials before a definitive diagnosis was made. In addition, corticosteroid treatment was empirically administered to 15 patients (35%) before the diagnosis, with indications such as suspicion of inflammatory processes or symptom relief. In 38 patients (88%), the first performed fungal diagnostic test was positive. Nineteen patients (44%) required admission to the intensive care unit, and 11 patients (26%) died during their hospital stay.
Conclusion
There was a delay in diagnosis of patients with pulmonary blastomycosis, largely attributable to the lack of consideration of the etiological agent. Novel approaches to assist providers in recognizing the illness earlier and trigger evaluation are needed.
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Data availability
The data that support the findings of this study are available from the corresponding author, JO, upon reasonable request.
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Funding
This publication was supported by NIH/NCRR/NCATS CTSA Grant Number UL1 TR002377. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
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AT and YP: contributed equally to the design of the study, data collection, and preparation of the manuscript, JO and OG: supervised the study process and contributed to manuscript drafting and editing, VH and BP: contributed to the design of the study, PV: provided critical revision and edits to the manuscript draft. All the authors approved the last version of the manuscript and its submission to the journal. BWP: has received fees for board membership, has patents (planned, pending, or issued, funds paid to his institution), has received royalties, and has stock/stock options (all not related to the current work) from Ambient Clinical Analytics. JCO: has received grants from Nference, Inc and the MITRE corporation outside the present work. The other authors report no competing interests.
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JCO has received grants from Nference, Inc. and the MITRE corporation outside the present work. He has also received personal consulting fees from Bates college and Elsevier, inc, also outside the present work. These funds had no influence on acquisition, analysis, interpretation and reporting of pooled data for this manuscript.
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15010_2022_1875_MOESM1_ESM.tif
Supplementary figure Duration from the initial symptoms to the diagnosis for different patient categories. a: all patients, b: according to the extent of the disease, c: according to presentation with arthralgia or rash, d: in-hospital mortality. Patients who were asymptomatic or did not have an unequivocal symptom start date (n = 5) were excluded from the analyses (TIF 734 KB)
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Tekin, A., Pinevich, Y., Herasevich, V. et al. Diagnostic delay in pulmonary blastomycosis: a case series reflecting a referral center experience. Infection 51, 193–201 (2023). https://doi.org/10.1007/s15010-022-01875-y
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DOI: https://doi.org/10.1007/s15010-022-01875-y