Blastomycosis

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Blastomycosis
Classification and external resources
An introduction to dermatology (1905) blastomycosis.jpg
Skin lesions of blastomycosis.
ICD-10B40
ICD-9116.0
DiseasesDB1439
MedlinePlus000102
eMedicinemed/231 ped/254
MeSHD001759
 
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The term "South American blastomycosis" is sometimes used to describe an infection with Paracoccidioides brasiliensis,[1] though the term Paracoccidioidomycosis is more frequently used to describe this condition.
Blastomycosis
Classification and external resources
An introduction to dermatology (1905) blastomycosis.jpg
Skin lesions of blastomycosis.
ICD-10B40
ICD-9116.0
DiseasesDB1439
MedlinePlus000102
eMedicinemed/231 ped/254
MeSHD001759

Blastomycosis (also known as "North American blastomycosis," "Blastomycetic dermatitis," and "Gilchrist's disease"[2]) is a fungal infection caused by the organism Blastomyces dermatitidis. Endemic to portions of North America, blastomycosis causes clinical symptoms similar to histoplasmosis.[3]

Cause[edit]

B. dermatitidis is asexual form of Ajellomyces dermatitidis. (These can be differentiated on basis of presence or absence of "A Antigen", B. dermatitidis being positive for it.) It is a dimorphic fungus.

Pathogenesis[edit]

Blastomyces dermatitidis from a lesion in dog.

Inhaled conidia of B. dermatitidis are phagocytosed by neutrophils and macrophages in alveoli. Some of these escape phagocytosis and transform into yeast phase rapidly. Having thick walls, these are resistant to phagocytosis and express glycoprotein BAD-1, which is a virulence factor as well as an epitope. In lung tissue, they multiply and may disseminate through blood and lymphatics to other organs, including the skin, bone, genitourinary tract, and brain. The incubation period is 30 to 100 days, although infection can be asymptomatic.

Signs and symptoms[edit]

Blastomycosis can present in one of the following ways:

Diagnosis[edit]

Once suspected, the diagnosis of blastomycosis can usually be confirmed by demonstration of the characteristic broad based budding organisms[4] in sputum or tissues by KOH prep, cytology, or histology. Tissue biopsy of skin or other organs may be required in order to diagnose extra-pulmonary disease. Blastomycosis is histologically associated with granulomatous nodules. Commercially available urine antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where the organism is not readily detected. While culture of the organism remains the definitive diagnostic standard, its slow growing nature can lead to delays in treatment of up to several weeks.

However, sometimes blood and sputum cultures may not detect blastomycosis;[5] lung biopsy is another option, and results will be shown promptly.

Treatment[edit]

Itraconazole given orally is the treatment of choice for most forms of the disease. Ketoconazole may also be used. Cure rates are high, and the treatment over a period of months is usually well tolerated. Amphotericin B is considerably more toxic, and is usually reserved for immunocompromised patients who are critically ill and those with central nervous system disease. Patients who cannot tolerate deoxycholate formulation of Amphotericin B can be given lipid formulations. Fluconazole has excellent CNS penetration and is useful where there is CNS involvement after initial treatment with Amphotericin B.

Prognosis[edit]

Mortality rate in treated cases

Epidemiology[edit]

In the United States, blastomycosis is endemic in the Mississippi river and Ohio river basins and around the Great Lakes. The annual incidence is less than 1 case per 100,000 people in Mississippi, Louisiana, Kentucky, and Arkansas. The cases are greater in northern states such as Wisconsin, where from 1986 to 1995 there were 1.4 cases per 100,000 people.[6] It also frequently affects hunting dogs in northern Wisconsin and the upper Mississippi and Wisconsin Rivers.[7]

In Canada, most cases of blastomycosis occur in Northwestern Ontario, particularly around the Kenora and areas like Killarney (Georgian Bay) Area. The moist, acidic soil in the surrounding woodland harbors the fungus.

Blastomycosis is distributed internationally; cases are sometimes reported from Africa.[8]

History[edit]

Blastomycosis was first described by Thomas Casper Gilchrist[9] in 1894 and sometimes goes by the eponym Gilchrist's disease.[10] It is also sometimes referred to as Chicago Disease.

Additional images[edit]

See also[edit]

References[edit]

  1. ^ "South American Blastomycosis: Overview - eMedicine Dermatology". Retrieved 2009-03-08. 
  2. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 319. ISBN 0-7216-2921-0. 
  3. ^ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 676–8. ISBN 0-8385-8529-9. 
  4. ^ Veligandla SR, Hinrichs SH, Rupp ME, Lien EA, Neff JR, Iwen PC (October 2002). "Delayed diagnosis of osseous blastomycosis in two patients following environmental exposure in nonendemic areas". Am. J. Clin. Pathol. 118 (4): 536–41. doi:10.1309/JEJ0-3N98-C3G8-21DE. PMID 12375640. 
  5. ^ "Rare fungal infection often misdiagnosed". CTV News. Retrieved 2011-11-28. "Doctors are warning about a rare and serious infection called Blastomycosis that is often being misdiagnosed." 
  6. ^ Centers for Disease Control and Prevention (CDC) (1996). "Blastomycosis--Wisconsin, 1986-1995". MMWR Morb. Mortal. Wkly. Rep. 45 (28): 601–3. PMID 8676851. 
  7. ^ Pet Center Blasto in Dogs
  8. ^ Alvarez G, Burns B, Desjardins M, Salahudeen S, AlRashidi F, Cameron D (2006). "Blastomycosis in a young African man presenting with a pleural effusion". Can Respir J 13 (8): 441–4. PMC 2683332. PMID 17149463. 
  9. ^ "Thomas Caspar Gilchrist (www.whonamedit.com)". Retrieved 2008-12-10. 
  10. ^ "Gilchrist's disease (www.whonamedit.com)". Retrieved 2008-12-10. 

External links[edit]