In a rural medical center in Upstate New York, we observed an increase in pulmonary blastomycosis cases. Herein, we highlight the increased prevalence of blastomycosis in our region, and our experience with the diagnostic dilemma resulting in delayed diagnosis. This delay may have resulted in an increased mortality. A high index of suspicion may help hasten the diagnosis in an otherwise nonendemic area. A single-center retrospective case series of all patients diagnosed with culture-proven blastomycosis is reported at the Bassett Medical Center from 2007 to 2019. Eight cases of confirmed pulmonary blastomycosis were identified. All patients resided in a rural area along the Susquehanna River Basin. Only one case had a travel history to an endemic state. Males accounted for 100% of cases. There was a 50% mortality rate from acute respiratory distress syndrome. Bronchoalveolar lavage (BAL) reliably made the diagnosis. About 40% of patients had a false-negative blastomycosis serology. There was an average delay of 2.5 months from presentation to correct diagnosis due to a lack of consideration for blastomycosis. BAL resulted in a correct diagnosis, while serology was not reliable to exclude the diagnosis. Physicians should include blastomycosis in the diagnostic differential cases of nonresolving pneumonia in Upstate New York, an area not previously considered as endemic. Bronchoalveolar remains the evaluation method of choice if blastomycosis is suspected.


中文翻译：

---

纽约州北部农村地区的肺母细胞菌病：一个病例系列和文献综述。


在纽约州北部的一个农村医疗中心，我们观察到肺母细胞增多症病例增加。在本文中，我们着重指出了我们地区的芽孢杆菌病患病率上升，以及我们在诊断难题中的经验，导致诊断延迟。这种延迟可能导致死亡率增加。高怀疑指数可能有助于加快在非流行地区的诊断。巴塞特医学中心（Bassett Medical Center）从2007年至2019年报告了所有经培养证实的芽孢杆菌病确诊患者的单中心回顾性病例系列。确定了8例确诊的肺芽孢杆菌病病例。所有患者均居住在萨斯奎哈纳河流域的农村地区。只有一例有旅行到流行病的历史。男性占病例的100％。急性呼吸窘迫综合征的死亡率为50％。可靠地诊断了支气管肺泡灌洗（BAL）。约40％的患者患有假阴性的胚芽菌病血清学。由于没有考虑到芽孢杆菌病，从出现到正确诊断平均延迟了2.5个月。BAL导致正确的诊断，而血清学不能可靠地排除诊断。在纽约州北部（以前未被认为是地方病）的诊断性非分辨性肺炎病例中，医师应包括芽孢杆菌病。如果怀疑有芽孢菌病，则支气管肺泡仍然是首选的评估方法。由于没有考虑到芽孢菌病，从出现到正确诊断需要5个月。BAL导致正确的诊断，而血清学不能可靠地排除诊断。在纽约州北部（以前未被认为是地方病）的诊断性非分辨性肺炎病例中，医师应包括芽胞菌病。如果怀疑有芽孢菌病，则支气管肺泡仍然是首选的评估方法。由于没有考虑到芽孢菌病，从出现到正确诊断需要5个月。BAL导致正确的诊断，而血清学不能可靠地排除诊断。在纽约州北部（以前未被认为是地方病）的诊断性非分辨性肺炎病例中，医师应包括芽孢杆菌病。如果怀疑有芽孢菌病，则支气管肺泡仍然是首选的评估方法。