Table 1.
summary of Descriptions of Blastomycosis Case Vignettes, Percentage of Respondent Wisconsin Primary Care Physicians Diagnosing Blastomycosis, and Top 3 Diagnoses suggested for each Vignette
| Patient Characteristics | |||||||
|---|---|---|---|---|---|---|---|
| Age | Gender | County of Residencea | Other Counties Visiteda | Case Scenario in Brief | Blastomycosis Clinical Categoryb | Respondents Diagnosing Blastomycosisc | Top 3 Diagnoses |
| 42 | M | “Fox Valley” (1-4) | Washburn (3) “northern Wisconsin” (1-4) | 1 month cough, sore throat, dyspnea, chest congestion, low-grade fever, weight loss; RML infiltrate; computer technician; camping, canoeing and pets | 2 | 13/26 (50%) | Pneumonia, cancer, blastomycosis |
| 31 | M | Manitowoc (4) | “Northern Wisconsin” (1-4) | 11 weeks of cough and rib/back pain, weight loss, no fever; smoker; painter; mold exposure; hunting and fishing; LLL consolidation | 4 | 15/35 (43%) | Pneumonia, blastomycosis, “fungal” |
| 54 | F | Racine (4) | None mentioned | 3 weeks of cough, febrile, night sweats, dyspnea, fatigue; obesity; rheumatoid arthritis on prednisone/methotrexate; unemployed; became hypoxemic, had signs of ARDs | 3 | 3/25 (12%) | Pneumonia; noninfectious, nonmalignant pulmonary process; complication of non pulmonary disease |
| 56 | M | Milwaukee (4) | None mentioned | Skin lesions and progressive dyspnea, cough, chills, weight loss; no fever; history of sarcoidosis; truck driver, no recent outdoor activities; LuL mass, mediastinal adenopathy | 4, D | 2/26 (8%) | Noninfectious, nonmalignant pulmonary process; cancer; pneumonia |
| 31 | M | Kewaunee (5) | None mentioned | 2-3 weeks of cough, hemoptysis, dyspnea, chest/back discomfort, fatigue, weight loss; works outdoors as welder; fume exposure; LML/LLL infiltrates | 2 | 5/36 (14%) | Pneumonia; cancer; noninfectious, nonmalignant pulmonary process |
| 29 | M | Milwaukee (4) | None mentioned | Pleuritic chest, back and scapular pain, productive cough, night sweats; afebrile; machine tool and steel fabricator; LuL mass | 4 | 2/25 (8%) | Cancer, pneumonia, tuberculosis/mycobacterium |
| 48 | M | Kenosha (4) | None mentioned | 2 months of cough, low-grade fever, chest congestion, weight loss; then night sweats, chills, hemoptysis; engineer, works indoors; lung abscess, pulmonic process and hemoptysis | 4 | 3/31 (10%) | Pneumonia. tuberculosis/mycobacterium. cancer |
| 47 | M | Milwaukee (4) | None mentioned | 4 days of dyspnea, cough; diabetes, hypertension, hyperlipidemia; computer technician; bilateral lung infiltrates, increased pulmonary vascular congestion with normal heart size | 3 | 0/23 (0%) | Cardiac disease; pneumonia; noninfectious, nonmalignant pulmonary process |
Abbreviations: LUL, left upper lobe; LML, left middle lobe; LLL, left lower lobe; RML, right middle lobe; ARDS, acute respiratory distress syndrome
Categories of county specific mean annual reported blastomyosis incidence per 100,000 population adapted from reference 14: Category 1 county incidence is > 20 cases/100,000 population; category 2 is > 5 to 20; category 3 is > 2 to 5; category 4 is <2; category 5 is no cases.
Clinical category of blastomycosis corresponding to illness presented in the vignette. Blastomycosis clinical categories: category 1 – Asymptomatic (no vignettes sent in this category); category 2 – Acute localized pneumonia; category 3 – ARDS; category 4 – Subacute to chronic infiltrate and/or cavitary disease; D – Dissemination from lungs to other organs, bone, or skin.
Number of respondents who included blastomycosis as a diagnosis for this vignette divided by the number of reviews of this vignette (%).