Symptoms of pulmonary blastomycosis: northern Wisconsin, United States.

OBJECTIVE

Pulmonary disease is the most common manifestation of the systemic fungal infection, blastomycosis. This study examines symptoms of pulmonary blastomycosis and possible age and gender differences in a 22-year case series.

METHODS

Laboratory-confirmed cases of blastomycosis were identified from mandatory reports to the Vilas County Health Department (1984--2001) and from hospital records and case contacts before mandated reports (November 1979--1983). Symptoms were ascertained by interviews of respondent cases (or next of kin) by using a standard form. Proportions were compared with the chi-square test or Fisher exact test.

RESULTS

One hundred seventy cases of blastomycosis (mean age 44, 56% male) were identified and pulmonary manifestations were present in 154 (91%). Of the 118 interviewed cases, the following symptoms were common: cough (90%), fever (75%), night sweats (68%), weight loss (66%), chest pain (63%), dyspnea (54%), and aches (50%). Hemoptysis occurred in 18%, and nearly all queried patients had fatigue. The dyad of cough and fever occurred in 73%, and triads of fever-cough-night sweats, fever-cough-weight loss, and fever-cough-chest pain occurred in 58%, 57%, and 51%, respectively. Among men, fever (P = .03), cough and fever (P = .03), fever-cough-weight loss (P = .03), and fever-cough-night sweats (P = .03) were less common in those 50 years of age and older. Symptoms did not vary by duration of illness.

CONCLUSIONS

Cough, fever, night sweats, weight loss, chest pain, dyspnea, and aches are common symptoms of pulmonary blastomycosis. Symptom constellations that included fever were less common in men 50 years of age and older. There was no apparent difference in symptoms between acute and chronic blastomycosis.