Published case fatality in blastomycosis patients ranges between 4% and 78%. This study aimed to assess mortality associated with blastomycosis and identify its associated risk factors. We conducted a systematic review of publications related to Blastomyces dermatitidis available in PubMed and Scopus databases. Studies that reported data on blastomycosis mortality and that were published from inception through February 2018 were assessed and included in the analysis. Using the R meta package, a random-effect model meta-analysis was used to calculate pooled and stratified estimates of case-fatality proportions and risk ratios. Of 1553 publications, we included 20 studies reporting on a total of 2820 cases of blastomycosis between 1970 and 2014 and three case series reports with 10, 21, and 36 patients. The mean or median ages ranged from 28 to 59 years. Mortality was defined as attributable mortality caused by blastomycosis in 13 studies. Among 14 studies with a standard error ≤0.05, the overall pooled mortality was 6.6% (95% confidence interval [CI], 4.9-8.2) with 57% heterogeneity. The mortality rate was 37% (95% CI, 23-51) in immunocompromised patients and 75% (95% CI, 53-96) in patients who developed an acute respiratory distress syndrome (ARDS) (n = 3 studies each). ARDS was the only identified risk factor in general patients (risk ratio = 10.2). The overall mortality was significantly higher in studies involving immunocompromised patients and ARDS patients. Our analysis showed considerable heterogeneity among studies. Inconsistent mortality definitions may have contributed to the observed heterogeneity. Further research is needed to assess potential risk factors for mortality.

中文翻译：

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与皮肤芽孢杆菌感染相关的死亡率：文献和荟萃分析的系统综述。

在胚芽菌病患者中已公布的病例死亡率为4％至78％。这项研究旨在评估与芽孢杆菌病相关的死亡率并确定其相关的危险因素。我们对PubMed和Scopus数据库中可获得的与皮肤芽孢杆菌相关的出版物进行了系统的综述。从报告开始到2018年2月，发表了报道母细胞菌病死亡率数据的研究，并将其纳入分析。使用R meta软件包，使用随机效应模型荟萃分析来计算病死率和风险比的汇总和分层估计。在1553个出版物中，我们纳入了20项研究，报告了1970年至2014年之间总共2828例芽孢菌病病例，以及3例病例系列报告，涉及10、21和36例患者。平均年龄或中位数年龄为28至59岁。死亡率在13项研究中定义为归因于芽孢杆菌病的死亡率。在14个标准误≤0.05的研究中，总合并死亡率为6.6％（95％置信区间[CI]，4.9-8.2），异质性为57％。免疫功能低下患者的死亡率为37％（95％CI，23-51），发展为急性呼吸窘迫综合征（ARDS）的患者死亡率为75％（95％CI，53-96）（每组3项研究）。在一般患者中，ARDS是唯一确定的危险因素（危险比= 10.2）。在涉及免疫功能低下患者和ARDS患者的研究中，总体死亡率明显更高。我们的分析表明研究之间存在相当大的异质性。死亡率定义不一致可能导致了观察到的异质性。