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Blastomycosis

Blastomycoses


Presentation

In about 50% of the cases, the disease does not produce any symptoms. In cases, when it does, the following signs are evident in individuals affected with blastomycosis:

When the infection spreads to other body parts and affects the skin [7], then the symptoms include:

  • Development of papules that resemble warts or ulcers
  • Bleeding from the ulcers
  • Nose and mouth are the common areas of occurrence
  • The warts are painless and can be grayish to violet in color
Fever
  • There was no history of pulmonary disease, in particular fever, coughing, or hemoptysis. Final pathohistologic evaluation after resection revealed B. dermatitidis infection.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 25-year-old Hispanic woman presented with fever, sweats, neck pain, and an enlarging neck mass with purulent discharge after sustaining a C6 vertebral body fracture.[ncbi.nlm.nih.gov]
  • More than one-half of all patients had symptoms that included fever, cough, weight loss, night sweats, and pleuritic chest pain. Virtually all were previously healthy, and most did not have an outdoor occupation.[ncbi.nlm.nih.gov]
  • She continued to have symptoms of fever, chills, night sweats with productive cough and dyspnea and presented to the hospital five days later. She denied hemoptysis.[pubmedcentral.nih.gov]
  • There were more systemic findings, including fever (P .01), poor intake (P .01), elevated white blood cell count (P .01), and elevated C-reactive protein level (P .01), in children with isolated pulmonary disease than in children with extrapulmonary disease[ncbi.nlm.nih.gov]
Weight Loss
  • An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss.[ncbi.nlm.nih.gov]
  • We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • More than one-half of all patients had symptoms that included fever, cough, weight loss, night sweats, and pleuritic chest pain. Virtually all were previously healthy, and most did not have an outdoor occupation.[ncbi.nlm.nih.gov]
  • Blastomycosis can present as an acute pneumonia which is often misdiagnosed as acute pneumococcal pneumonia or the infection may present as a chronic pneumonia along with weight loss, night sweats, hemoptysis, and a lung mass suggesting tuberculosis or[ncbi.nlm.nih.gov]
  • Based on a survey of 176 dog owners, principal disease characteristics for canine blastomycosis were anorexia, lethargy, shortness of breath, chronic cough, and weight loss.[ncbi.nlm.nih.gov]
Chills
  • She continued to have symptoms of fever, chills, night sweats with productive cough and dyspnea and presented to the hospital five days later. She denied hemoptysis.[pubmedcentral.nih.gov]
  • In cases, when it does, the following signs are evident in individuals affected with blastomycosis: Fever accompanied by chills Myalgia Cough Chest pain Joint pain Undue fatigue Unexplained weight loss Night sweats Malaise When the infection spreads to[symptoma.com]
  • Infection may result in a flu-like illness with fever, chills and cough. Some patients develop a serious lung infection.[algomapublichealth.com]
  • Generalized symptoms may include fever, chills, cough, and/or difficulty breathing (dyspnea). In the chronic phase of the disease, the lungs and skin are most frequently affected. The genitourinary tract and bones may also be involved. (NORD/G.[dermis.net]
  • It usually presents as a flu -like illness with fever , chills, productive cough, myalgia, arthralgia and pleuritic chest pain .[medicinenet.com]
Malaise
  • He subsequently developed a cough, malaise, fever, nausea, vomiting, and diarrhea. He was admitted to the hospital and intubated for worsening pulmonary symptoms. Microscopic examination of his sputum indicated Blastomyces dermatitidis.[ncbi.nlm.nih.gov]
  • (the sputum may be brown or bloody skin lesions, or small draining ulcer(s) on the skin, like a small abscess - draining bloody or purulent (pus) material - found most common on the face, neck, and the extremities. shortness of breath fever fatigue malaise[blastomycosis.ca]
  • In cases, when it does, the following signs are evident in individuals affected with blastomycosis: Fever accompanied by chills Myalgia Cough Chest pain Joint pain Undue fatigue Unexplained weight loss Night sweats Malaise When the infection spreads to[symptoma.com]
  • Symptoms may include: Joint pain Chest pain Cough (may produce brown or bloody mucus) Fatigue Fever and night sweats General discomfort, uneasiness, or ill feeling ( malaise ) Muscle pain Unintentional weight loss Most people develop skin symptoms when[medlineplus.gov]
Anemia
  • […] series, cases of laryngeal carcinoma, adrenal insufficiency, thyroid nodules, granulomatous hypercalcemia, abnormal mammograms thought to represent breast carcinoma, otitis media with cranial extension, immune thrombocytopenic purpura, and hemolytic anemia[ncbi.nlm.nih.gov]
  • If present, anemia and nutritional deficiencies should be treated.[emedicine.medscape.com]
Cough
  • There was no history of pulmonary disease, in particular fever, coughing, or hemoptysis. Final pathohistologic evaluation after resection revealed B. dermatitidis infection.[ncbi.nlm.nih.gov]
  • An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss.[ncbi.nlm.nih.gov]
  • We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes.[ncbi.nlm.nih.gov]
  • We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • She denied symptoms of cough or phlegm. She was diagnosed with musculoskeletal pain and discharged home on analgesics. Five days later she presented with ongoing symptoms of fever, chills with dry cough and right lower chest pain.[pubmedcentral.nih.gov]
Productive Cough
  • We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes.[ncbi.nlm.nih.gov]
  • We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • Facts : Pulmonary fungal infection endemic to Great Lakes, and Mississippi and Ohio River basins Usually affects lung, skin, bones/joints, and prostate History / PE : Low grade fevers, productive cough, weight loss Ulcerated skin lesions , lytic bone[medlibes.com]
  • It usually presents as a flu -like illness with fever , chills, productive cough, myalgia, arthralgia and pleuritic chest pain .[medicinenet.com]
  • It usually presents as a flu -like illness with fever, chills, productive cough, myalgia, arthralgia and pleuritic chest pain.[medicinenet.com]
Dyspnea
  • An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss.[ncbi.nlm.nih.gov]
  • He complained of fever, dyspnea, cough, and chest pain. A chest radiograph showed dense right lower-lobe consolidation and bilateral patchy infiltrates in the upper lobes.[doi.org]
  • Generalized symptoms may include fever, chills, cough, and/or difficulty breathing (dyspnea). In the chronic phase of the disease, the lungs and skin are most frequently affected. The genitourinary tract and bones may also be involved. (NORD/G.[dermis.net]
  • Google Scholar Access Volume 7, Issue 3 May 2005, pp. 171-173 Abstract An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea[doi.org]
  • Symptoms include a productive or dry hacking cough, chest pain, dyspnea, fever, chills, and drenching sweats. Pleural effusion occurs occasionally.[msdmanuals.com]
Hemoptysis
  • There was no history of pulmonary disease, in particular fever, coughing, or hemoptysis. Final pathohistologic evaluation after resection revealed B. dermatitidis infection.[ncbi.nlm.nih.gov]
  • An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss.[ncbi.nlm.nih.gov]
  • We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes.[ncbi.nlm.nih.gov]
  • Blastomycosis can present as an acute pneumonia which is often misdiagnosed as acute pneumococcal pneumonia or the infection may present as a chronic pneumonia along with weight loss, night sweats, hemoptysis, and a lung mass suggesting tuberculosis or[ncbi.nlm.nih.gov]
  • Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Lymphadenopathy and pleural effusions may be uncommonly present. Promoted articles (advertising)[radiopaedia.org]
  • Pleural effusion occurs occasionally. Some patients have rapidly progressive infections, and acute respiratory distress syndrome may develop. In extrapulmonary disseminated blastomycosis, symptoms depend on the organ involved.[msdmanuals.com]
  • Chest x-rays are abnormal in two-thirds of patients and “may reveal alveolar or mass like infiltrates, reticulonodular pattern, pleural effusion, and, rarely, cavitation”. MRI and CT scans may also reveal some skeletal lesions or involvement.[austincc.edu]
  • A second chest radiograph showed pneumothorax and pleural effusion. Thoracentisis was performed, and empyema was diagnosed.[doi.org]
  • effusions are uncommon. 72 MRI is the preferred imaging modality for CNS disease and is frequently abnormal in patients with CNS blastomycosis. 58 Treatment Guidelines for the diagnosis and treatment of blastomycosis are published by the Infectious Disease[ncbi.nlm.nih.gov]
Anterior Uveitis
  • Subsequently, an ophthalmologist diagnosed anterior uveitis and initiated topical corticosteroid therapy. Worsening symptoms prompted performance of computed tomography of the chest, which suggested thyroid involvement.[ncbi.nlm.nih.gov]
Myalgia
  • It usually presents as a flu -like illness with fever , chills, productive cough, myalgia, arthralgia and pleuritic chest pain .[medicinenet.com]
  • It usually presents as a flu -like illness with fever, chills, productive cough, myalgia, arthralgia and pleuritic chest pain.[medicinenet.com]
  • Blastomycosis Pathology Type Fungus Cause(s) Inhalation of fungus Symptoms Fever, chills, myalgia, headache, dry cough, night sweats, skin lesions, Mortality Rate Up to 68% Treatments Itraconazole, Ketoconazole, Amphotericin B, Show Information Appearances[house.wikia.com]
  • It presents with flu-like symptoms including fever, chills, cough, pleuritic chest pain and myalgias. It may lead to a chronic granulomatous pulmonary infection and disseminate to other anatomic sites including skin, nervous system and bones.[fpnotebook.com]
  • In cases, when it does, the following signs are evident in individuals affected with blastomycosis: Fever accompanied by chills Myalgia Cough Chest pain Joint pain Undue fatigue Unexplained weight loss Night sweats Malaise When the infection spreads to[symptoma.com]
Arthralgia
  • It usually presents as a flu -like illness with fever , chills, productive cough, myalgia, arthralgia and pleuritic chest pain .[medicinenet.com]
  • It usually presents as a flu -like illness with fever, chills, productive cough, myalgia, arthralgia and pleuritic chest pain.[medicinenet.com]
  • A previously well 35-year-old man developed fevers, cough, chest pain, shortness of breath, fatigue, skin lesions, and prominent arthralgias 2 weeks before admission to the hospital. A chest radiograph revealed bilateral patchy infiltrates.[doi.org]
  • […] people with blastomycosis have symptoms, while immunocompromised patients can have the disease spread beyond the lungs to other organs like the skin and bones.Blastomycosis can present in one of the following ways: a flu-like illness with fever, chills, arthralgia[en.wikipedia.org]
Thigh Pain
  • METHODS: We report on a 37-year-old Arabian woman who presented initially with progressive low back and anterior thigh pain without precipitating trauma. She was found to have 2 draining fistulas.[ncbi.nlm.nih.gov]
Subcutaneous Nodule
  • nodules, which present as infected skin abscesses and are often associate with a blastomycosis infection of the lungs;  Bone and joint infection, which commonly affect the long bones , ribs , and vertebrae;  Genitourinary tract infections, which account[medicalook.com]
  • It can also manifest itself as subcutaneous nodules, genitourinary infections, joint infections, as well as other organ infections.[4][5] Symptoms can manifest anywhere from 3 to 15 weeks from the time of inoculation, with 50% of the infected population[austincc.edu]
  • nodules may occur, which spontaneously drain and form chronic, sometimes non-healing ulcerations. 3,8 Isolated pustular blastomycosis involving the face, abdomen and trunk is noted in both immunocompromised and healthy individuals. 7 Primary cutaneous[the-dermatologist.com]
Skin Ulcer
  • The clinical profile of a case of disseminated blastomycosis with pulmonary changes and skin ulcers was described.[ncbi.nlm.nih.gov]
Neck Mass
  • CASE PRESENTATION: A 25-year-old Hispanic woman presented with fever, sweats, neck pain, and an enlarging neck mass with purulent discharge after sustaining a C6 vertebral body fracture.[ncbi.nlm.nih.gov]

Workup

Various tests are required to confirm the diagnosis of blastomycosis. One of the best methods to confirm the disease is fungal culture. For this, samples are taken from blood, urine, bone marrow, sputum, liver and skin which are tested for the presence of fungus.

Hemoglobin Decreased
  • Hemoglobin decreased to 97 g/L. BUN, serum creatinine, electrolytes, AST, ALT, GGT and ALP were normal. Urinalysis was negative. Blood, urine and sputum cultures remained negative. Sputum gram stain showed 3-4 neutrophils without organisms.[pubmedcentral.nih.gov]
Pleural Effusion
  • Lymphadenopathy and pleural effusions may be uncommonly present. Promoted articles (advertising)[radiopaedia.org]
  • Pleural effusion occurs occasionally. Some patients have rapidly progressive infections, and acute respiratory distress syndrome may develop. In extrapulmonary disseminated blastomycosis, symptoms depend on the organ involved.[msdmanuals.com]
  • Chest x-rays are abnormal in two-thirds of patients and “may reveal alveolar or mass like infiltrates, reticulonodular pattern, pleural effusion, and, rarely, cavitation”. MRI and CT scans may also reveal some skeletal lesions or involvement.[austincc.edu]
  • A second chest radiograph showed pneumothorax and pleural effusion. Thoracentisis was performed, and empyema was diagnosed.[doi.org]
  • effusions are uncommon. 72 MRI is the preferred imaging modality for CNS disease and is frequently abnormal in patients with CNS blastomycosis. 58 Treatment Guidelines for the diagnosis and treatment of blastomycosis are published by the Infectious Disease[ncbi.nlm.nih.gov]

Treatment

For mild cases of blastomycosis, no treatment may be required if the fungus stays in the dormant state in the lungs. However, if the individuals experience some kind of mild symptoms, then antifungal medications such as intraconazole are recommended.

For more severe cases, a rigorous treatment regime is required. In such cases, treatment with amphotericin B is recommended [8]. In addition, newer generation of antifungal drugs have also been introduced that include voriconazole and posaconazole; but there efficacy in treating blastomycosis is still being tested [9].

Amphotericin B is administered through the intravenous route. Some patients may experience certain side effects with this medicine. Therefore, for individuals who are unable to tolerate deoxycholate formulation of amphotericin B, lipid formulas of voriconazole are given that are well tolerated and are reported to have better CNS penetration [10]. Lipid formulations include flucanozole that is known to be effective against blastomycosis and in cases when the CNS is involved.

Prognosis

The prognosis of the disease is quite favorable with prompt initiation of treatment. Individuals can completely recover from the disease. However, in cases when the treatment is delayed it can even cause death. Immunocompromised patients may have a 29% mortality rate [5].

Complications

Complications arise when the disease is not treated on time and the fungus has attacked other body parts. The following are the various complications of blastomycosis:

Etiology

The fungus Blastomyces dermatitidis causes blastomycosis. It resides in the soils and rotten woods near lakes and rivers. The fungus is thought to grow like cottony white mold; as its actual growth features has never been observed in the nature.

Blastomycosis is known to peak during the spring and autumn season when the weather is moist and favors optimal growth of the fungus.

Epidemiology

The exact incidence of blastomycosis is unknown. However, annual incidence is reported to be 1 in every 100,000 individuals. United States is known to have a large prevalence of blastomycosis. City of Rockford, Ilionis has higher prevalence of blastomycosis with 6.67 cases per 100,000 populations. Although hyperendemic areas like Arkansas, Mississippi, Kentucky and Wesconsin has an incidence rate of up to 40 cases per 100,000 population [1]. There are no significant sex predilection from common source infection data [2]. Blastomycosis occurs in all ages from infancy to the elderly [3].

Sex distribution
Age distribution

Pathophysiology

Blastomyces dermatitidis is a type of dimorphic fungus; wherein the spores of the fungi that get converted to yeast are infectious to humans. The fungus gains entry into the body through the lungs and can stay in the lungs for a prolonged period. It has been estimated that about 50% of individuals affected by this fungus remain asymptomatic. In rest of the cases, the incubation period is about 45 days.

After gaining entry, the fungus multiplies and begins affecting the blood and other organs. Individuals complain of pulmonary problems and in some cases, the disease can also affect the bones, skin and the brain. Immunocompromised host like those suffering with acquired immune-deficiency syndrome (AIDS) are more prone of blastomycosis infection [4].

Prevention

So far no vaccine has been introduced to provide prevention against blastomycosis. Individuals with weak immune system are more prone to contract the fungus and are advised to avoid going to such areas. However, absolute prevention from the fungus is a bit difficult in the endemic areas. It is thus recommended that individuals take immediate steps to treat infection in order to avoid onset of secondary complications.

Summary

Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, a fungus found in wood and moist soil. When individuals breathe in the aerosolized spores of this fungus they develop blastomycosis. The fungus gains entry through the lungs and produces no signs and symptoms if it does not spread to other body parts.

Blastomycosis is more common in inhabitants of Eastern North America, St. Lawrence River Valley, and Central Appalachian Mountains. This condition was first described in the year 1894 by Thomas Casper Gilchrist and hence often referred to as Gilchrist’s disease.

Patient Information

Definition

Blastomycosis is a fungal infection that may cause flu like symptoms in affected individuals. The causative agent in this case is blastomyces dermatitidis. Blastomycosis precipitates as lung infections and if not treated on time can have life threatening complications.

Cause

The fungus known as blastomyces dermatitidis is known to cause blastomycosis. This fungus resides in moist soil and wood. Individuals who inhale the fungus present often with flu like symptoms. 

Symptoms

In many individuals, the fungus stays in inactive state inside the lungs and do not cause any symptoms. In cases when they do, treatment is required to ward off the infection. Symptoms of blastomycosis include fever along with chills, night sweats, fatigue, unexplained weight loss, cough with sputum, chest pain, muscle pain and joint pain.

Diagnosis

Various methods are required for diagnosing the condition. Fungal culture from body fluids is the best way to diagnose blastomycosis. In addition, other tests such as CT scan of the chest, skin biopsy, and chest x-ray along with urine culture are also done. Sputum culture is considered to be one of the best methods to detect the fungus. Diagnosing the condition in children is difficult as they do not produce sputum to be taken for analysis. Therefore, for children invasive procedures need to be performed for arriving at definitive diagnosis.

Treatment

Individuals with mild symptoms require no treatment. Antifungal medications are prescribed for those with moderate to severe symptoms. In severe cases, a rigorous treatment regime is required to clear off the fungus from the body and intravenous administration of amphotericin B is employed. However, certain individuals will exhibit side effects and in such cases lipid formulation of antifungal agents are helpful.

References

Article

  1. Klein BS, Vergeront JM, Weeks RJ, Kumar UN, Mathai G, Varkey B, et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. Feb 27 1986; 314(9):529-34.
  2. Pfister JR, Archer JR, Hersil S, Boers T, Reed KD, Meece JK, et al. Non-rural point source blastomycosis outbreak near a yard waste collection site. Clin Med Res. Jun 2011; 9(2):57-65.
  3. Varkey B. Blastomycosis in children. Semin Respir Infect. Sep 1997; 12(3):235-42.
  4. Pappas PG, Pottage JC, Powderly WG, Fraser VJ, Stratton CW, McKenzie S, et al. Blastomycosis in patients with the acquired immunodeficiency syndrome. Ann Intern Med. May 15 1992; 116(10):847-53.
  5. Pappas PG, Threlkeld MG, Bedsole GD, Cleveland KO, Gelfand MS, Dismukes WE. Blastomycosis in immunocompromised patients. Medicine (Baltimore). Sep 1993; 72(5):311-25.
  6. Meyer KC, McManus EJ, Maki DG. Overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome. N Engl J Med. Oct 21 1993; 329(17):1231-6.
  7. Chapman SW, Lin AC, Hendricks KA, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. Sep 1997; 12(3):219-28.
  8. Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. Jun 15 2008; 46(12):1801-12.
  9. Rooney PJ, Sullivan TD, Klein BS. Selective expression of the virulence factor BAD1 upon morphogenesis to the pathogenic yeast form of Blastomyces dermatitidis: evidence for transcriptional regulation by a conserved mechanism. Mol Microbiol. Feb 2001; 39(4):875-89.
  10. Bariola JR, Perry P, Pappas PG, Proia L, Shealey W, Wright PW, et al. Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era. Clin Infect Dis. Mar 15 2010; 50(6):797-804.

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Last updated: 2019-07-11 22:15