364. The Capital District of New York State, Likely a New Blastomycosis Endemic Region. (26th November 2018) - McDonald, Robert
Abstract: Background: Blastomycosis is a commonly misdiagnosed infection caused by Blastomyces spp. It is not reportable in New York State (NYS), but where reportable, yearly incidence is 1–2/100, 000 persons. In October 2017, a physician notified the NYS Department of Health (NYSDOH) of six blastomycosis cases seen during April 2016–July 2017 in the nonendemic eastern upstate area known as the Capital District (CD). NYSDOH investigated to determine the possibility of locally acquired blastomycosis. Methods: NYS hospital blastomycosis discharge codes from the January 2007–December 2016 Statewide Planning and Research Cooperative System dataset were reviewed. To better understand illness in the area of highest incidence, NYSDOH contacted CD physicians to identify patients diagnosed with blastomycosis during April 2016–February 2018. Chart reviews and interviews were conducted to obtain travel and disease progression details. Results: During 2007–2016, there were 279 blastomycosis diagnoses in NYS. Mean annual blastomycosis diagnoses during 2007–2015 was 24 (incidence: 0.1/100, 000 persons); in 2016, there were 59 blastomycosis diagnoses (incidence: 0.3/100, 000 persons). A CD county had the highest state incidence, with a rate increase from 2.0/100, 000 persons during 2007–2015 to 4.1/100, 000 persons during 2016. CD physicians provided contact and clinical information for the six initially-identified patients and two additional patients seen during April 2016–February 2018. All experienced delays in diagnosis, seven lacked travel history, two had cutaneous blastomycosis, three had pulmonary blastomycosis, and three had disseminated blastomycosis. One died from blastomycosis and another required long-term ventilator support. Seven cases were identified by culture or histopathology; the diagnostic method for one was unknown. Conclusion: One CD county had blastomycosis rates similar to known endemic areas; patients lacked travel history to endemic areas, indicating locally acquired blastomycosis might have occurred. To improve prompt diagnosis, NYS clinicians and laboratorians should consider blastomycosis in patients with pneumonia, even without travel history to endemic areas. Further evaluation is needed to determine whether the endemic area of NYS has expanded. Disclosures: All authors: No reported disclosures.