Patient Characteristics and Treatment of Fungal Infections in the Marshfield Clinic Health Care System

Matthew Buchholz
Matthew Buchholz
University of Wisconsin
Stevens Point

Matthew Buchholz, Jennifer Anderson, Jennifer Meece
Integrated Research and Development Laboratory

Research area: Clinical Research, Infectious Diseases

Background: Fungal diseases are an emerging threat to human health. As the population of immunocompromised individuals grows, an increased number of people are at risk of contracting a potentially fatal fungal infection. To better understand the patient characteristics associated with contracting fungal infections, we analyzed the demographics, comorbidities, and treatment of patients within the Marshfield Clinic Health Care System (MCHCS).

Methods: Cases were identified by the presence of a positive fungal culture with growth of Aspergillus spp., Blastomyces dermatitidis, Cryptococcus spp., or Histoplasma capsulatum and onset of symptoms from 2003-2013. A total of 906 patient charts were abstracted to identify demographics (gender, age, and race), presence or absence of 13 comorbidities, and antifungal treatment from the Combined Medical Record of the MCHCS. SAS version 9.3 was used for statistical analysis.

Results: Of the 906 cases, 604, 247, 38, and 17 represented Aspergillus spp., B. dermatitidis, Cryptococcus spp., and H. capsulatum infections, respectively. Combined cases ranged from 36-134 annually. All infection types showed propensity towards infecting males. B. dermatitidis infected individuals were younger than individuals with Aspergillus spp. or Cryptococcus spp. (p less than 0.001). Presence of at least one comorbidity ranged from 48-87% with hypertension, chronic obstructive pulmonary disease, diabetes, and cancer being the most common across all cases. The pulmonary tract was the most commonly infected site in all infection types. Pulmonary cases were significantly more likely to be hospitalized than non-pulmonary cases in all infections except H. capsulatum. The percent of patients receiving antifungal treatment varied from 32% of Aspergillus spp. cases to 98% of B. dermatitidis cases.

Conclusions: Our findings are consistent with other studies showing that fungal infections are most often pulmonary, accompanied by comorbidities, and more commonly infect males. Further studies are warranted to precisely determine risk factors of contracting a fungal infection.