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2005 Abstracts
97
BLASTOMYCOSIS IN ONTARIO: A PAEDIATRIC CASE AND EPIDEMIOLOGIC REPORT, 1994-2003
S Morris, J Brophy, L Ford-Jones, S Richardson, P Sarsfield, R Summerbell, P Parkin, F Jamieson
The Hospital for Sick Children, Toronto, Ontario
BACKGROUND: Blastomyces dermatitidis is a thermally dimorphic environmental fungus known to infect both children and adults. While this organism is known to be endemic in parts of Canada (Ontario, Manitoba, Quebec, and New Brunswick), in the absence of provincial reporting systems, the incidence and geographic distribution of this potentially fatal systemic fungal infection is not known.
OBJECTIVE: To describe the province-wide and regional incidence of blastomycosis within Ontario.
METHODS: Review of laboratory-confirmed cases identified by the Ontario Central Public Health Laboratory (CPHL), November 1994 to December 2003, to determine the point of diagnosis, age and sex of cases.
RESULTS: 309 cases were identified in all 7 health regions of Ontario over the study period. Incidence over our study period was 0.30 cases per 100 000. The largest number of cases was from the North Ontario region (n=188) for an incidence of 2.44 cases per 100,000. In the Toronto region, 66 cases were confirmed for an incidence of 0.29 per 100,000. The majority of cases were reported from 2001 to 2003 inclusive (57%); most frequently diagnosed from October to March (58%), and a male predominance (65%) was observed. Children and youth aged 19 years and younger constituted 13% of cases.
CONCLUSIONS: The 309 cases of blastomycosis diagnosed in Ontario between 1994 and 2003 reported herein substantially increase the total number of known cases in both Ontario and Canada. The recent increase in blastomycosis diagnoses may in part be due to an education campaign of clinicians in northwestern Ontario, but this disease likely remains under-recognized in other regions of the province. As delay in diagnosis can contribute to morbidity and mortality, it is important that paediatricians consider blastomycosis in their differential diagnosis of lung, skin, and bone lesions, particularly if the child does not respond to conventional therapy, and that they be aware of hyperendemic locations such as that surrounding Kenora. We would advocate for the resumption of blastomycosis as a reportable disease in Canadian provinces, such that tracking of cases and clinician education regarding this potentially fatal invasive fungal infection may be facilitated.