BLASTOMYCOSIS IN NORTHEAST TENNESSEE

Study objectives: To study the epidemiologic and clinical features of blastomycosis in northeast Tennessee. Design: Retrospective review of blastomycosis cases in the region from 1980 through 1995, Setting: Hos pitals located in the Tri-Cities region of northeast Tennessee. Patien ts: Seventy-two patients with confirmed blastomycosis infection. Inter ventions: None. Results: During the 1980 to 1995 study period, we docu mented 72 cases of blastomycosis. The mean age was 52 years (range, 13 to 86 years), most were male (69.4%), and nine were immunocompromised . A possible environmental exposure was noted for 28 patients. Pulmona ry involvement represented the most common site: of infection (61 case s), but multiorgan involvement was common (17 cases). Most patients wi th pulmonary blastomycosis (66%) presented with a chronic illness, and radiologic findings usually revealed local consolidation or a mass-li ke lesion. Nine patients developed ARDS with an associated mortality r ate of 89%, compared with a 10% mortality for non-ARDS pulmonary cases . Antifungal treatment regimens varied widely, with amphotericin B oft en used for sicker patients. An epidemiologic evaluation revealed that the mean yearly incidence rate for blastomycosis quadrupled between 1 980 and 1987 (0.31 cases/ 100,000 population) and 1988 to 1995 (1.23 c ases/100,000 population) (p=0.00001). Most new blastomycosis cases in the 1988 to 1995 period occurred in three counties in the region where significant new construction projects have been underway. Conclusion: Blastomycosis is endemic in northeast Tennessee and the number of cas es is increasing, coinciding with major new construction in the region . Clinicians in the area must be alert to this condition.