Potentially preventable? A case of recurrent blastomycosis involving the central nervous system
Bibliographic record
Abstract
Background: Blastomycosis is a disease caused by infection with thermally dimorphic fungi belonging to the genus Blastomyces. Central nervous system (CNS) involvement occurs in an estimated 1% to 10% of patients with blastomycosis, and treatment requires at least 12 months of antifungal therapy. Methods: We describe a 32-year-old male who presented with recurrent blastomycosis involving the CNS. Results: The patient was initially diagnosed with pulmonary blastomycosis with possible involvement of the CNS approximately 1 year prior to his current presentation. At that time, he was treated with amphotericin B deoxycholate and then subsequently transitioned to oral voriconazole. On discharge he only filled his voriconazole prescription for 8 weeks out of a planned year-long treatment course, due to an inability to afford it. He subsequently re-presented with symptoms of headache, nausea, and ataxia, and was found to have a right-sided cerebellar abscess. The abscess was drained and Blastomyces sp was isolated on culture. Following surgery, the patient was once again started on voriconazole after completing a course of liposomal amphotericin B. Social work was engaged early on during this admission. Fortunately, the patient's financial situation had improved and medication cost was no longer a barrier. When seen in follow-up, he remained on oral therapy and was doing well. Conclusions: A case of recurrent blastomycosis with involvement of the CNS is presented, where treatment failure occurred due to an inability of the patient to afford the required medication. Medication cost should always be considered and discussed with a patient when developing a treatment plan.
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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 | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".