Pulmonary-Critical Care and Infectious Diseases, Roudebush VA Medical Center and Indiana University, Indianapolis, IN 46202, USA.
Chest. 2010 Dec;138(6):1377-82. doi: 10.1378/chest.10-0627. Epub 2010 Jun 17.
The endemic region of blastomycosis historically has included the state of Indiana. However, few published reports of blastomycosis exist to substantiate this distinction. A surge of patients with blastomycosis in central Indiana (Indianapolis and surrounding counties) beginning in 2005 prompted us to review our local experience. We propose that this surge was related to major highway construction around Indianapolis.
We reviewed all microbiologically confirmed cases from four hospitals serving central Indiana. Chart review was completed for adult patients, and data were collected on clinical presentations, methods of diagnosis, comorbidities, radiologic findings, treatment, and outcomes. We plotted patient residence addresses with sites of highway construction.
Fifty-nine patients were identified from laboratory results and physician referral. Interestingly, a surge of blastomycosis incidence occurred in 34 patients between 2005 and 2008 during which time major highway projects were under way around the Indianapolis metropolitan area. The majority of these patients presented acutely and with pulmonary involvement. Fungal culture and antigen testing were the most sensitive means to diagnosis. Antifungal therapy was highly effective.
This urban outbreak of blastomycosis in Indianapolis should prompt clinicians to consider blastomycosis in this highly endemic area of histoplasmosis.
Blastomycosis 的流行地区历史上包括印第安纳州。然而，很少有关于 Blastomycosis 的已发表报告来证实这一区别。自 2005 年以来，印第安纳州中部（印第安纳波利斯及周边县）的 Blastomycosis 患者激增，促使我们回顾了我们的本地经验。我们提出，这种激增与印第安纳波利斯周围的主要公路建设有关。
我们回顾了四家服务于印第安纳州中部的医院的所有微生物学确诊病例。对成年患者进行了图表回顾，并收集了临床表现、诊断方法、合并症、影像学发现、治疗和结果的数据。我们将患者的居住地址与高速公路建设地点进行了绘图。
从实验室结果和医生转诊中确定了 59 名患者。有趣的是，在 2005 年至 2008 年间，随着印第安纳波利斯大都市区周围的主要公路项目的进行，有 34 名患者的 Blastomycosis 发病率激增。这些患者大多急性发作，肺部受累。真菌培养和抗原检测是诊断最敏感的手段。抗真菌治疗非常有效。
印第安纳波利斯的这次城市暴发的 Blastomycosis 应该促使临床医生在这个高度地方性的组织胞浆菌病流行地区考虑 Blastomycosis。
