{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:30:41Z","timestamp":1791725441717,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T00:00:00Z","timestamp":1584403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007015","name":"University of Wisconsin-Madison","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007015","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical and Translational Science Award (CTSA) program","award":["UL1TR002373"],"award-info":[{"award-number":["UL1TR002373"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1T4002373"],"award-info":[{"award-number":["UL1T4002373"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective study of adult patients with proven blastomycosis from 2004\u20132016 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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u20137.7%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa276","type":"journal-article","created":{"date-parts":[[2020,3,14]],"date-time":"2020-03-14T12:36:34Z","timestamp":1584189394000},"page":"1594-1602","source":"Crossref","is-referenced-by-count":54,"title":["Clinical Manifestations and Outcomes in Immunocompetent and Immunocompromised Patients With Blastomycosis"],"prefix":"10.1093","volume":"72","author":[{"given":"Joseph A","family":"McBride","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA"},{"name":"Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana K","family":"Sterkel","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA"},{"name":"Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Matkovic","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee T","family":"Broman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne N","family":"Gibbons-Burgener","sequence":"additional","affiliation":[{"name":"Wisconsin Department of Health Services, Division of Public Health, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M","family":"Gauthier","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"key":"2021050500303120300_CIT0001","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.ccm.2017.04.006","article-title":"Clinical manifestations and treatment of Blastomycosis","volume":"38","author":"McBride","year":"2017","journal-title":"Clin Chest Med"},{"key":"2021050500303120300_CIT0002","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01661-19","article-title":"Human Blastomycosis in South Africa caused by Blastomyces percursus and Blastomyces emzantsi sp. nov., 1967\u20132014","author":"Maphanga","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2021050500303120300_CIT0003","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1186\/s12879-016-1847-x","article-title":"Development and validation of a novel single nucleotide polymorphism (SNP) panel for genetic analysis of Blastomyces spp. and association analysis","volume":"16","author":"Frost","year":"2016","journal-title":"BMC Infect Dis"},{"key":"2021050500303120300_CIT0004","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1093\/infdis\/jis756","article-title":"Variation in clinical phenotype of human infection among genetic groups of Blastomyces dermatitidis","volume":"207","author":"Meece","year":"2013","journal-title":"J Infect Dis"},{"key":"2021050500303120300_CIT0005","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1126\/science.1124105","article-title":"Global control of dimorphism and virulence in fungi","volume":"312","author":"Nemecek","year":"2006","journal-title":"Science"},{"key":"2021050500303120300_CIT0006","doi-asserted-by":"crossref","first-page":"e1003464","DOI":"10.1371\/journal.ppat.1003464","article-title":"Structure and function of a fungal adhesin that binds heparin and mimics thrombospondin-1 by blocking T cell activation and effector function","volume":"9","author":"Brandhorst","year":"2013","journal-title":"PLoS Pathog"},{"key":"2021050500303120300_CIT0007","doi-asserted-by":"crossref","first-page":"5746","DOI":"10.4049\/jimmunol.168.11.5746","article-title":"BAD1, an essential virulence factor of Blastomyces dermatitidis, suppresses host TNF-alpha production through TGF-beta-dependent and -independent mechanisms","volume":"168","author":"Finkel-Jimenez","year":"2002","journal-title":"J Immunol"},{"key":"2021050500303120300_CIT0008","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.chom.2016.02.001","article-title":"Fungal mimicry of a mammalian aminopeptidase disables innate immunity and promotes pathogenicity","volume":"19","author":"Sterkel","year":"2016","journal-title":"Cell Host Microbe"},{"key":"2021050500303120300_CIT0009","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1399-3062.2007.00227.x","article-title":"Blastomycosis in solid organ transplant recipients","volume":"9","author":"Gauthier","year":"2007","journal-title":"Transpl Infect Dis"},{"key":"2021050500303120300_CIT0010","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1399-3062.2011.00658.x","article-title":"A multicenter study of histoplasmosis and Blastomycosis after solid organ transplantation","volume":"14","author":"Grim","year":"2012","journal-title":"Transpl Infect Dis"},{"key":"2021050500303120300_CIT0011","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/tid.12186","article-title":"Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET)","volume":"16","author":"Kauffman","year":"2014","journal-title":"Transpl Infect Dis"},{"key":"2021050500303120300_CIT0012","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/00005792-200205000-00004","article-title":"Endemic mycoses in a cancer hospital","volume":"81","author":"Torres","year":"2002","journal-title":"Medicine"},{"key":"2021050500303120300_CIT0013","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/00007611-199407000-00008","article-title":"Blastomycosis and human immunodeficiency virus: three new cases and review","volume":"87","author":"Witzig","year":"1994","journal-title":"South Med J"},{"key":"2021050500303120300_CIT0014","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.2165\/00003495-200969110-00002","article-title":"Endemic fungal infections in patients receiving tumour necrosis factor-alpha inhibitor therapy","volume":"69","author":"Smith","year":"2009","journal-title":"Drugs"},{"key":"2021050500303120300_CIT0015","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1086\/588660","article-title":"Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group","volume":"46","author":"De Pauw","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2021050500303120300_CIT0016","doi-asserted-by":"crossref","first-page":"4873","DOI":"10.1128\/JCM.42.10.4873-4875.2004","article-title":"Antigen assay with the potential to aid in diagnosis of Blastomycosis","volume":"42","author":"Durkin","year":"2004","journal-title":"J Clin Microbiol"},{"key":"2021050500303120300_CIT0017","doi-asserted-by":"crossref","first-page":"285","DOI":"10.3109\/13693780903103952","article-title":"Genetic diversity in Blastomyces dermatitidis: implications for PCR detection in clinical and environmental samples","volume":"48","author":"Meece","year":"2010","journal-title":"Med Mycol"},{"key":"2021050500303120300_CIT0018","volume-title":"Wisconsin communicable diseases report 2016","author":"Wisconsin Department of Health Services, Division of Public Health, Bureau of Communicable Diseases","year":"2018"},{"key":"2021050500303120300_CIT0019","doi-asserted-by":"crossref","first-page":"e105466","DOI":"10.1371\/journal.pone.0105466","article-title":"Incidence and trends of Blastomycosis-associated hospitalizations in the United States","volume":"9","author":"Seitz","year":"2014","journal-title":"PLoS One"},{"key":"2021050500303120300_CIT0020","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2174\/1570162043485077","article-title":"CD8+ T-cells: function and response to HIV infection","volume":"2","author":"Gulzar","year":"2004","journal-title":"Curr HIV Res"},{"key":"2021050500303120300_CIT0021","doi-asserted-by":"crossref","first-page":"e1004148","DOI":"10.1371\/journal.ppat.1004148","article-title":"Tc17 cells mediate vaccine immunity against lethal fungal pneumonia in immune deficient hosts lacking CD4+ T cells","volume":"10","author":"Nanjappa","year":"2014","journal-title":"PLoS Pathog"},{"key":"2021050500303120300_CIT0022","doi-asserted-by":"crossref","first-page":"735","DOI":"10.3389\/fimmu.2017.00735","article-title":"Cellular and molecular defects underlying invasive fungal infections-revelations from endemic mycoses","volume":"8","author":"Lee","year":"2017","journal-title":"Front Immunol"},{"key":"2021050500303120300_CIT0023","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4103\/1742-6413.67106","article-title":"Case study documenting the diagnosis of idiopathic CD4+ lymphocytopenia in a patient with atypical fungal infection (disseminated Blastomycosis) by FNA of adrenal mass","volume":"7","author":"Siderits","year":"2010","journal-title":"Cytojournal"},{"key":"2021050500303120300_CIT0024","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jaci.2015.07.043","article-title":"GATA2 deficiency underlying severe Blastomycosis and fatal herpes simplex virus-associated hemophagocytic lymphohistiocytosis","volume":"137","author":"Spinner","year":"2016","journal-title":"J Allergy Clin Immunol"},{"key":"2021050500303120300_CIT0025","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1378\/chest.114.2.436","article-title":"Blastomycosis in northeast Tennessee","volume":"114","author":"Vasquez","year":"1998","journal-title":"Chest"},{"key":"2021050500303120300_CIT0026","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1378\/chest.15-0289","article-title":"Blastomycosis in Indiana: clinical and epidemiologic patterns of disease gleaned from a multicenter retrospective study","volume":"148","author":"Azar","year":"2015","journal-title":"Chest"},{"key":"2021050500303120300_CIT0027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1053\/adpa.2001.21473","article-title":"Acute respiratory distress syndrome and Blastomycosis: presentation of nine cases and review of the literature","volume":"5","author":"Lemos","year":"2001","journal-title":"Ann Diagn Pathol"},{"key":"2021050500303120300_CIT0028","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1093\/clind\/15.4.629","article-title":"Epidemiology of Blastomycosis in a region of high endemicity in North Central Wisconsin","volume":"15","author":"Baumgardner","year":"1992","journal-title":"Clin Infect Dis"},{"key":"2021050500303120300_CIT0029","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1055\/s-0035-1562899","article-title":"Histoplasmosis: up-to-date evidence-based approach to diagnosis and management","volume":"36","author":"Hage","year":"2015","journal-title":"Semin Respir Crit Care Med"},{"key":"2021050500303120300_CIT0030","doi-asserted-by":"crossref","first-page":"308","DOI":"10.3201\/eid2302.160505","article-title":"Risk factors for disseminated coccidioidomycosis, United States","volume":"23","author":"Odio","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"2021050500303120300_CIT0031","doi-asserted-by":"crossref","first-page":"e01224","DOI":"10.1128\/mBio.01224-19","article-title":"Investigation of genetic susceptibility to Blastomycosis reveals interleukin-6 as a potential susceptibility locus","volume":"10","author":"Merkhofer","year":"2019","journal-title":"MBio"},{"key":"2021050500303120300_CIT0032","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/cid\/cit366","article-title":"A large community outbreak of Blastomycosis in Wisconsin with geographic and ethnic clustering","volume":"57","author":"Roy","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2021050500303120300_CIT0033","doi-asserted-by":"crossref","first-page":"e1005493","DOI":"10.1371\/journal.pgen.1005493","article-title":"The dynamic genome and transcriptome of the human fungal pathogen Blastomyces and close relative Emmonsia","volume":"11","author":"Mu\u00f1oz","year":"2015","journal-title":"PLoS Genet"},{"key":"2021050500303120300_CIT0034","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.4049\/jimmunol.1303089","article-title":"The unappreciated intracellular lifestyle of Blastomyces dermatitidis","volume":"194","author":"Sterkel","year":"2015","journal-title":"J Immunol"},{"key":"2021050500303120300_CIT0035","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.diagmicrobio.2010.09.015","article-title":"Detection of Blastomyces dermatitidis antigen in patients with newly diagnosed Blastomycosis","volume":"69","author":"Bariola","year":"2011","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2021050500303120300_CIT0036","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1086\/588300","article-title":"Clinical practice guidelines for the management of Blastomycosis: 2008 update by the Infectious Diseases Society of America","volume":"46","author":"Chapman","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2021050500303120300_CIT0037","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1164\/rccm.2008-740ST","article-title":"An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients","volume":"183","author":"Limper","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2021050500303120300_CIT0038","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1093\/cid\/ciw305","article-title":"Isavuconazole treatment of cryptococcosis and dimorphic mycoses","volume":"63","author":"Thompson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2021050500303120300_CIT0039","doi-asserted-by":"crossref","first-page":"e3538","DOI":"10.1097\/MD.0000000000003538","article-title":"Management and outcomes of acute respiratory distress syndrome caused by Blastomycosis: a retrospective case series","volume":"95","author":"Schwartz","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"2021050500303120300_CIT0040","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1056\/NEJM199310213291704","article-title":"Overwhelming pulmonary Blastomycosis associated with the adult respiratory distress syndrome","volume":"329","author":"Meyer","year":"1993","journal-title":"N Engl J Med"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa276\/33166762\/ciaa276.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/9\/1594\/37792670\/ciaa276.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/9\/1594\/37792670\/ciaa276.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:40:31Z","timestamp":1620175231000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/72\/9\/1594\/5807998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,17]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,3,17]]},"published-print":{"date-parts":[[2021,5,4]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa276","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2020,3,17]]}}}