{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T20:04:57Z","timestamp":1784405097905,"version":"3.55.0"},"reference-count":81,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T00:00:00Z","timestamp":1596758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Fonds voor Wetenschappelijk Onderzoek\u2013Vlaanderen, which funded"},{"name":"Public Health Ontario, which funded"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Blastomycosis has been reported from countries in Africa and the Middle East, but a decades-long debate has persisted regarding whether this is the same disease known in North America and caused by Blastomyces dermatitidis and Blastomyces gilchristii.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We reviewed published cases of human and veterinary blastomycosis from Africa and the Middle East. We abstracted epidemiological and clinical features of cases, including sites of disease, diagnosis, management, outcomes, and, where available, genetic and antigenic typing of case isolates. In addition, we sequenced nucleic acids from 9 clinical isolates from Africa deposited in global collections as B. dermatitidis; for 5, we sequenced the internal transcribed spacer regions, and for the other 4 we sequenced the whole genomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 172 unique human patients with blastomycosis, including 159 patients from 25 African countries and 12 patients from 5 Middle Eastern countries, and also identified 7 reports of veterinary blastomycosis. In humans, cutaneous disease predominated (n = 100\/137, 73%), followed by pulmonary (n = 73\/129, 57%) and osteoarticular involvement (n = 61\/128, 48%). Unusual direct microscopy\/histopathological presentations included short hyphal fragments in tissues (n = 23\/129, 18%). There were 34 genotyped case isolates that comprised 4 species: Blastomyces percursus (n = 22, 65%), from 8 countries throughout all regions; Blastomyces emzantsi (n = 9, 26%), from South Africa; B. dermatitidis (n = 1, 3%), from the Democratic Republic of Congo; and B. gilchristii (n = 2, 6%), from South Africa and Zimbabwe.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Blastomycosis occurs throughout Africa and the Middle East and is caused predominantly by B. percursus and, at least in South Africa, B. emzantsi, resulting in distinct clinical and pathological patterns of disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1100","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T19:28:59Z","timestamp":1596569339000},"page":"e1560-e1569","source":"Crossref","is-referenced-by-count":45,"title":["Blastomycosis in Africa and the Middle East: A Comprehensive Review of Reported Cases and Reanalysis of Historical Isolates Based on Molecular Data"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7522-0281","authenticated-orcid":false,"given":"Ilan S","family":"Schwartz","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose F","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris R","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Clinical Sciences Unit, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-9462","authenticated-orcid":false,"given":"Nelesh P","family":"Govender","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa"},{"name":"Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"McTaggart","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsidiso G","family":"Maphanga","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Richardson","sequence":"additional","affiliation":[{"name":"Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Becker","sequence":"additional","affiliation":[{"name":"Belgian Coordinated Collections of Microorganisms (BCCM\/IHEM) Fungal Collection, Mycology and Aerobiology, Sciensano, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A","family":"Cuomo","sequence":"additional","affiliation":[{"name":"Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan G","family":"McEwen","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad de Antioquia, Medell\u00edn, Colombia"},{"name":"Cellular and Molecular Biology Unit, Corporaci\u00f3n para Investigaciones Biol\u00f3gicas, Medell\u00edn, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne","family":"Sigler","sequence":"additional","affiliation":[{"name":"Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada"},{"name":"UAMH Centre for Global Microfungal Diversity, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,7]]},"reference":[{"key":"2021100522220580600_CIT0001","first-page":"496","article-title":"Protozoan dermatitis","volume":"12","author":"Gilchrist","year":"1894","journal-title":"J Cutan Gen Dis"},{"key":"2021100522220580600_CIT0002","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1084\/jem.3.1.53","article-title":"A case of pseudo-lupus vulgaris caused by a blastomyces","volume":"3","author":"Gilchrist","year":"1898","journal-title":"J Exp 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