The average diagnostic delay of blastomycosis was 27 days, with 17% of patients experiencing delays of over a month. Most cases seen had ‘community-acquired pneumonia’. A retrospective analysis from a US study by Desmond Barber and colleagues reported pre-existing pulmonary conditions, diabetes mellitus and respiratory therapies as risk factors for delayed diagnosis of blastomycosis. 41% of 3,825 patients experienced at least one missed diagnostic opportunity, with an average of 3.2 missed visits before diagnosis. 60% of the missed opportunities occurred primarily in outpatient settings.
This study emphasises the need for physicians to increase their clinical suspicion for blastomycosis as a differential diagnosis of a chest infection, thereby supporting an early diagnosis and reducing the need for inpatient treatment. In addition, to achieve a timely diagnosis, the knowledge about risk factors for missed opportunities will be very helpful and hopefully impact patient clinical outcomes.
The clinical presentation, physical examination findings, and radiographic findings of blastomycosis are non-specific and may mimic other clinical entities, such as pneumonia and lung cancer. Beyond this ambiguity in its presentation, diagnoses may be further delayed by limited diagnostic availability.
