361. Changing Epidemiology of <i>Blastomyces dermatitidis</i> Infection in Quebec, Canada: A Retrospective Multicenter Study
Bibliographic record
Abstract
In the wake of the increased incidence of blastomycosis in Quebec province, Canada, clinicians have observed a possible increase of severity in patients, with occasional death. This study aimed to assess temporal changes in blastomycosis severity and mortality in Quebec, and to identify risk factors for mortality of blastomycosis. A retrospective multicenter cohort study of patients with confirmed blastomycosis identified in a database at the provincial laboratory (Laboratoire de santé public du Québec) between 1988 and 2016. Severe cases were defined as patients with septic shock and/or acute respiratory distress syndrome and/or requiring mechanical ventilation. Immunosuppression included corticosteroid use, HIV, immunosuppressive therapy for inflammatory disease, chemotherapy, and transplantation. The primary outcome was 90-day all-cause mortality. Risk factors for mortality were identified by multivariate logistic regression. Over the study period, 220 blastomycosis cases were identified. Medical charts for 176 patients from 17 institutions were available and complete for data collection. The median age of patients was 55.3 years (interquartile range 45–67). Infection led to hospitalization of 119 patients (68%). Pulmonary involvement was recorded for 81% of cases (142/176) and two organs or more were involved in 35% (61/176). An increase in severity was observed mainly in recent years [1988–1997: 1/32 (3%); 1998–2007: 9/54 (17%); 2008–2016: 19/89 (21%); P = 0.05]. The overall mortality was 17.6% (31/176); 6% (2/33) in 1988–1997, 20% (n = 11/54) in 1998–2007 and 20% in 2008- 2016 (n = 18/89) (P = 0.15). There was also a significant increase in age at diagnosis (P = 0.005), the proportion of diabetic patients (P = 0.03) and the proportion of immunocompromised patients (P = 0.009) over time. The independent risk factors of mortality were age (aOR 1.03 for each additional year, 95% CI 1.0–1.06, P = 0.05) and immunosuppression (aOR 3.62, 95% CI 1.54–8.49, P = 0.003). The severity of blastomycosis observed in Quebec over the past 30 years has increased. These changes could be explained in part by an increase in the number of immunosuppressed patients. However, mortality has remained stable in recent years. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".