PDF(Pubmed)
Abstract：
Blastomycosis is a disease caused by endemic fungi that ranges from severe pulmonary or disseminated to mild or asymptomatic. Environmental factors associated with it are not well described throughout the endemic area. We used the intramural State Inpatient Database from the Agency for Healthcare Research and Quality and ArcMap GIS to identify geographic high-risk clusters of blastomycosis hospitalizations in 13 states in the US endemic regions (AR, IA, IL, IN, KY, LA, MI, MN, MO, MS, OH, TN, and WI). We then used logistic regression to identify risk factors associated with these high-risk clusters. We describe six clusters of counties in which there was an elevated incidence of blastomycosis hospitalizations. We identified maximum mean annual temperature, percentage of persons aged ≥65 years, and mercury and copper soil content as being associated with high-risk clusters. Specifically, the odds of a county being part of a high-risk cluster was associated with increasing percentage of population over age 65, decreasing maximum temperature, increasing mercury, and decreasing copper soil content. Healthcare providers should be aware of these high-risk areas so that blastomycosis can be included, as appropriate, in a differential diagnosis for patients currently or previously residing in these areas.
摘要：
芽生菌病是由地方性真菌引起的疾病，范围从严重的肺部或播散到轻度或无症状。与之相关的环境因素在整个流行地区都没有得到很好的描述。我们使用了来自医疗保健研究与质量机构和ArcMapGIS的壁内州住院患者数据库，以确定美国流行地区13个州的胚真菌病住院的地理高风险集群（AR，IA,IL,IN,KY,洛杉矶,MI,MN,MO,MS,OH,TN,和WI）。然后，我们使用逻辑回归来识别与这些高风险集群相关的风险因素。我们描述了六个组群的县，其中芽生菌病住院发生率升高。我们确定了最高年平均气温，年龄≥65岁的人的百分比，汞和铜土壤含量与高风险集群相关。具体来说,一个县成为高风险集群的一部分的可能性与65岁以上人口的百分比增加，最高温度降低有关，增加汞，降低土壤铜含量。医疗保健提供者应该意识到这些高风险领域，以便可以包括芽生菌病，在适当的情况下,在目前或以前居住在这些地区的患者的鉴别诊断中。
