McBride Joseph A, Sterkel Alana K, Matkovic Eduard, Broman Aimee T, Gibbons-Burgener Suzanne N, Gauthier Gregory M
Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.
Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA.
Clin Infect Dis. 2021 May 4;72(9):1594-1602. doi: 10.1093/cid/ciaa276.
Blastomyces is a dimorphic fungus that infects persons with or without underlying immunocompromise. To date, no study has compared the clinical features and outcomes of blastomycosis between immunocompromised and immunocompetent persons.
A retrospective study of adult patients with proven blastomycosis from 2004-2016 was conducted at the University of Wisconsin. Epidemiology, clinical features, and outcomes were analyzed among solid-organ transplantation (SOT) recipients, persons with non-SOT immunocompromise (non-SOT IC), and persons with no immunocompromise (NIC).
A total of 106 cases met the inclusion criteria including 74 NIC, 19 SOT, and 13 non-SOT IC (malignancy, HIV/AIDS, idiopathic CD4+ lymphopenia). The majority of patients (61.3%) had at least 1 epidemiologic risk factor for acquisition of Blastomyces. Pneumonia was the most common manifestation in all groups; however, immunocompromised patients had higher rates of acute pulmonary disease (P = .03), more severe infection (P = .007), respiratory failure (P = .010), and increased mortality (P = .02). Receipt of SOT primarily accounted for increased severity, respiratory failure, and mortality in immunosuppressed patients. SOT recipients had an 18-fold higher annual incidence of blastomycosis than the general population. The rate of disseminated blastomycosis was similar among NIC, SOT, and non-SOT IC. Relapse rates were low (5.3-7.7%).
Immunosuppression had implications regarding the acuity, severity, and respiratory failure. The rate of dissemination was similar across the immunologic spectrum, which is in sharp contrast to other endemic fungi. This suggests that pathogen-related factors have a greater influence on dissemination for blastomycosis than immune defense.
芽生菌是一种双相真菌，可感染免疫功能正常或受损的人群。迄今为止，尚无研究比较免疫功能受损者和免疫功能正常者芽生菌病的临床特征和转归。
在威斯康星大学对2004年至2016年确诊为芽生菌病的成年患者进行了一项回顾性研究。对实体器官移植（SOT）受者、非SOT免疫功能受损者（非SOT IC）和无免疫功能受损者（NIC）的流行病学、临床特征和转归进行了分析。
共有106例病例符合纳入标准，其中74例为NIC，19例为SOT，13例为非SOT IC（恶性肿瘤、HIV/AIDS、特发性CD4+淋巴细胞减少症）。大多数患者（61.3%）至少有1个感染芽生菌的流行病学危险因素。肺炎是所有组中最常见的表现；然而，免疫功能受损患者的急性肺部疾病发生率更高（P = 0.03），感染更严重（P = 0.007），呼吸衰竭发生率更高（P = 0.010），死亡率更高（P = 0.02）。接受SOT主要导致免疫抑制患者病情加重、呼吸衰竭和死亡率增加。SOT受者芽生菌病的年发病率比普通人群高18倍。播散性芽生菌病的发生率在NIC、SOT和非SOT IC中相似。复发率较低（5.3 - 7.7%）。
免疫抑制对疾病的急性程度、严重程度和呼吸衰竭有影响。在整个免疫谱中播散率相似，这与其他地方性真菌形成鲜明对比。这表明病原体相关因素对芽生菌病播散的影响大于免疫防御。
