{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T20:56:37Z","timestamp":1778532997121,"version":"3.51.4"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T00:00:00Z","timestamp":1570147200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011625","name":"Marshfield Clinic Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dimorphic fungal infections, such as blastomycosis, cause significant morbidity and mortality. Historically, blastomycosis studies have focused on non-Hispanic whites, which limits our understanding of the clinical presentation and outcomes for patients of other races and ethnicities. We evaluated whether clinical presentation and disease severity varied across racial and ethnic groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blastomycosis patients were identified from Marshfield Clinic Health System and data were abstracted from electronic medical records. Blastomyces genotyping was performed for cases with available isolates. Bivariate analyses (\u03c7\u200a2 tests\/analysis of variance) assessed associations of race and\/or ethnicity, Blastomyces spp, and hospitalization status with demographics and clinical presentation. Multivariable logistic regression was used to evaluate the association of race and\/or ethnicity and hospitalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 477 patients were included. Age differences were observed across race and ethnicity categories (P &lt; .0001). Non-Hispanic whites were oldest (median, 48 years; interquartile range [IQR], 31\u201362) and Asians were youngest (26 years; IQR, 19\u201341). Non-Hispanic whites (55%) and African Americans (52%) had underlying medical conditions more frequently than Hispanic whites (27%) and Asians (29%). Odds of hospitalization were 2 to 3 times higher for Hispanic whites (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.2\u20131.7), American Indian or Alaska Native (AIAN) (aOR, 2.4; 95% CI, 1.0\u20135.5), and Asian (aOR, 1.9; 95% CI, 1.0\u20133.6) patients compared with non-Hispanic white patients. Ninety percent of Blastomyces dermatitidis infections occurred in non-Hispanic whites, whereas blastomycosis in Hispanic whites, AIAN, and Asian patients was frequently caused by Blastomyces gilchristii (P &lt; .0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hispanic whites, AIAN, and Asian blastomycosis patients were younger and healthier but more frequently hospitalized. Patients in these racial and ethnic groups may need more aggressive treatment and closer therapeutic monitoring.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofz438","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T03:46:33Z","timestamp":1570160793000},"source":"Crossref","is-referenced-by-count":12,"title":["Racial Differences in Clinical Phenotype and Hospitalization of Blastomycosis Patients"],"prefix":"10.1093","volume":"6","author":[{"given":"Jennifer L","family":"Anderson","sequence":"first","affiliation":[{"name":"Integrated Research and Development Laboratory, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holly M","family":"Frost","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer P","family":"King","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer K","family":"Meece","sequence":"additional","affiliation":[{"name":"Integrated Research and Development Laboratory, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,4]]},"reference":[{"key":"2019110112193427500_CIT0001","doi-asserted-by":"crossref","first-page":"e1004608","DOI":"10.1371\/journal.ppat.1004608","article-title":"Dimorphism in fungal pathogens of mammals, plants, and insects","volume":"11","author":"Gauthier","year":"2015","journal-title":"PLoS Pathog"},{"key":"2019110112193427500_CIT0002","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.mib.2007.04.002","article-title":"Dimorphism and virulence in fungi","volume":"10","author":"Klein","year":"2007","journal-title":"Curr Opin Microbiol"},{"key":"2019110112193427500_CIT0003","first-page":"00009","article-title":"A review on emerging fungal infections and their significance","volume":"1","author":"Ravikant","year":"2015","journal-title":"J Bacteriol Mycol"},{"key":"2019110112193427500_CIT0004","first-page":"416","article-title":"Insights into fungal morphogenesis and immune evasion: Fungal conidia, when situated in mammalian lungs, may switch from mold to pathogenic yeasts or spore-forming spherules","volume":"3","author":"Gauthier","year":"2008","journal-title":"Microbe Wash DC"},{"key":"2019110112193427500_CIT0005","first-page":"737","article-title":"Intracellular and extracellular defenses of human phagocytes against Blastomyces dermatitidis conidia and yeasts","volume":"105","author":"Drutz","year":"1985","journal-title":"J Lab Clin Med"},{"key":"2019110112193427500_CIT0006","doi-asserted-by":"crossref","first-page":"3543","DOI":"10.1128\/IAI.62.8.3543-3546.1994","article-title":"Altered expression of surface alpha-1,3-glucan in genetically related strains of Blastomyces dermatitidis that differ in virulence","volume":"62","author":"Hogan","year":"1994","journal-title":"Infect Immun"},{"key":"2019110112193427500_CIT0007","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1046\/j.1365-2958.1998.00697.x","article-title":"Histoplasma acquisition of calcium and expression of CBP1 during intracellular parasitism","volume":"27","author":"Batanghari","year":"1998","journal-title":"Mol Microbiol"},{"key":"2019110112193427500_CIT0008","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1128\/IAI.70.7.3443-3456.2002","article-title":"A parasitic phase-specific adhesin of Coccidioides immitis contributes to the virulence of this respiratory Fungal pathogen","volume":"70","author":"Hung","year":"2002","journal-title":"Infect Immun"},{"key":"2019110112193427500_CIT0009","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0891-5520(02)00038-7","article-title":"Blastomycosis","volume":"17","author":"Bradsher","year":"2003","journal-title":"Infect Dis Clin North Am"},{"key":"2019110112193427500_CIT0010","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1164\/ajrccm\/136.6.1333","article-title":"Two outbreaks of blastomycosis along rivers in Wisconsin. 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