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PubMed2002

Blastomycosis: The great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients.

Clinically, blastomycosis can be difficult to recognize even in the endemic areas where clinicians are aware of this problem. In only 18% of 123 patients from the University of Mississippi Medical Center (Jackson, MS) blastomycosis was correctly suspected at the initial patient evaluation. Pneumonia sensu latu (40%), malignant tumors (16%), and tuberculosis (14%) were the most common misdiagnoses. The false first impression frequently resulted in unnecessary surgeries or treatment delays, with patients receiving inefficient antibiotic therapy for months. The presence of cutaneous involvement by the disease makes its' recognition easier for the clinician, raising the percentage of correct initial diagnosis to 64%. To evaluate the association with immunodepression, the presence of other diseases was also searched among the 123 patients. An immunodepressive condition preceded the fungal disease in 25% of patients. Another associated disease commonly found in blastomycotic patients was diabetes mellitus (22%). Blastomycosis is correctly suspected at the first clinical evaluation in only a small percentage of patients; pneumonia, cancer, and tuberculosis are the most common clinical considerations. Cutaneous involvement leads the clinician to the correct diagnosis in the majority of cases. One fourth of the patients with blastomycosis had underlying immunodepressive conditions, and underlying diabetes mellitus is present in 22% of patients.

Adult↗

PubMedDate not supplied

Cervical manifestation of blastomycosis.

Blastomycosis is a common systemic fungal infection in which the physical and radiographic findings appear far more serious than the subjective signs and symptoms. Although blastomycosis of the head and neck is often difficult to diagnose, clues in the patient's history and a few laboratory tests can establish the diagnosis. Involvement of the skin and soft tissues provides an unusual opportunity for direct access to the organism for culture and pathologic diagnosis. We present a case of blastomycosis presenting in a single abscessed cervical lymph node. The diagnosis was established by fine-needle aspiration of the cervical mass. The primary lung disease was confirmed by chest radiography and computed tomography. The clinical and pathologic features of the disease are discussed. [Editorial comment: Pulmonary blastomycosis may present with cervical adenopathy. This article demonstrates the potential value of fine needle aspiration in establishing this diagnosis.]

Adult↗

PubMed1988

Epidemiologic and immunologic evaluation of an outbreak of canine blastomycosis.

Five confirmed cases of canine blastomycosis occurred over the 10-month period of December 1983 to September 1984 in a south-eastern Wisconsin colony of 30 dogs maintained for sled competition. Contrary to other published reports of canine blastomycosis, the sex-specific attack rates were higher among females than males. Four of the five confirmed cases and all four deaths occurred among young female dogs. Differences in the age distribution and/or the micro-environment of the females may have contributed at least in part to the difference in sex-specific attack rates. The serologic response and leukocyte function of the clinically affected and apparently healthy dogs from this colony were assessed during the outbreak. A survey of the adult dogs in the colony suggested that the mitogen-induced lymphocyte blastogenesis of dogs with clinical signs of blastomycosis was suppressed compared with that of dogs that remained free of clinical signs. In contrast to previous reports that autologous sera from dogs and humans with clinical blastomycosis inhibited mitogen-induced lymphocyte blastogenesis, lymphocyte responsiveness was similar to, or greater in the presence of autologous canine serum than it was in the presence of fetal bovine serum.

Animals↗

PubMed2000

Recurrent blastomycosis of the central nervous system: case report and review.

Although blastomycosis of the central nervous system (CNS) occurs in approximately 4% of patients with blastomycosis, recurrent CNS blastomycosis is very rare. We review the clinical features, treatment, and outcome of 4 previously reported cases. We also report a case of recurrent CNS blastomycosis successfully treated with surgery and liposomal amphotericin B after an inadequate response to amphotericin B therapy. This treatment may be an alternate approach for management of similar cases.

Amphotericin B↗

PubMed2005

The epidemiology of blastomycosis in Illinois and factors associated with death.

BACKGROUND: Blastomycosis is a systemic fungal disease that may be asymptomatic or progressive and may lead to death. METHODS: In response to a reported increase in the number of cases of blastomycosis in Illinois, surveillance data reported to the Illinois Department of Public Health from January 1993 to August 2003 were analyzed and the medical records of 4 patients who died were reviewed. RESULTS: Among the 500 cases reported, the median age of the patients was 43 years (range, 4-87 years), and 34 patients (7%) died. Higher rates of mortality were observed among persons who were black, who were > or =65 years of age, and who were male. The median time from onset of illness to diagnosis was 128 days (range, 12-489 days). Death was associated with a time from onset of illness to diagnosis of > or =128 days (OR, 2.1; 95% CI, 1.0-4.8). During the period from 1993 through 2002, the number of cases reported per year increased from 24 to 87 (P<.05). CONCLUSIONS: The incidence of blastomycosis has been increasing in Illinois. To reduce mortality related to delay in diagnosis and treatment, medical providers need to be educated about blastomycosis, with an emphasis on symptom recognition, methods of diagnosis, and appropriate antifungal treatment.

Adolescent↗

PubMed1994

Intraocular blastomycosis: case report and review.

Intraocular infection due to Blastomyces dermatitidis is rare, and only 10 cases have previously been reported. Manifestations of ocular blastomycosis can range from keratitis to panophthalmitis, and it is often difficult to diagnose ocular blastomycosis early. We report the case of a 45-year-old man who had disseminated blastomycosis that involved the lungs, skin, and ocular uvea and who was successfully treated with systemic and local antifungal therapy. We also review the literature describing the spectrum of clinical findings due to intraocular blastomycosis.

Amphotericin B↗

PubMed1992

Pulmonary blastomycosis.

Pulmonary blastomycosis has a number of chest radiographic manifestations that may closely resemble those of tuberculosis, histoplasmosis, and other fungal diseases. Radiographic presentations of disease include airspace consolidation, nodular opacities, air bronchograms, masslike lesions, and military disease. Because the geographic distribution of blastomycosis overlaps that of histoplasmosis, distinguishing one from the other on the basis of the radiographic features may be difficult. In blastomycosis, the paucity of calcifications, lymphadenopathy, and cavitation is striking. The article reviews the clinical and radiologic features of blastomycosis and provides illustrative cases to enhance understanding of this disease.

Blastomycosis↗

PubMed2006

Urine antigen detection of blastomycosis in pediatric patients.

Blastomycosis is an uncommonly recognized disease in pediatric patients. We describe 4 cases of pediatric blastomycosis that presented to our children's hospital, 2 with isolated pulmonary blastomycosis and 2 with disseminated blastomycosis. Because of variable clinical presentations and morbidity if treatment is delayed, physicians must maintain a high index of suspicion and obtain appropriate diagnostic tests promptly. For the first time, we report the effect of therapy on Blastomyces antigen clearance. In our experience, the urine antigen detection for B. dermatitidis is useful for diagnosis and follow up during therapy.

Adolescent↗

PubMedDate not supplied

Enzyme immunoassay detection of antibodies in canine blastomycosis using Blastomyces dermatitidis lysate antigens.

A Blastomyces dermatitidis yeast phase lysate antigen (T-58) prepared in our laboratory was used in an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies in 201 serum specimens from dogs with blastomycosis. In addition 36 sera from non-infected dogs from an endemic area for blastomycosis and 36 sera from non-infected dogs residing in a blastomycosis non-endemic area were assayed. Sensitivity values ranged from 96.2% (53 pre-treatment sera) to 88.5% (148 post-treatment sera) with the specimens from dogs with confirmed blastomycosis. Minimal reactivity was experienced with the sera from non-infected dogs. Positive reactions were obtained with 8.3% of the endemic area sera and with 5.6% of the sera from the non-endemic area. Mean ELISA index values ranged from 7.66 with the pretreatment sera to 1.11 and 1.03 with the endemic area sera and non-endemic area specimens respectively.

Animals↗

PubMed1991

SCH 39304 in the treatment of acute or established murine pulmonary blastomycosis.

SCH 39304 was tested for treatment of acute or established murine pulmonary blastomycosis and was compared with ketoconazole and fluconazole in a model of acute infection. Only SCH 39304 at 25 or 50 mg/kg of body weight per day produced 100% survival for 30 days after the 20-day treatment, although only 33% of the mice were cleared of infection. SCH 39304 at 2 mg/kg/day was similar to ketoconazole at 100 mg/kg/day and to fluconazole at 10 mg/kg/day. In a model of established blastomycosis, used to evaluate long-term treatment of very sick or moribund mice, SCH 39304 at 50 mg/kg/day protected against death with a 96% cumulative 8-week survival. SCH 39304 was clearly superior on a milligram-per-kilogram basis in acute blastomycosis, and long-term treatment of more severe blastomycosis was curative.

Animals↗

PubMed1973

Specific immunodiffusion test for blastomycosis.

A specific immunodiffusion test for blastomycosis has been developed. The test permitted the detection of approximately 80% of 113 proven cases of blastomycosis. Two diagnostically important precipitins designated A and B were frequently recognized in patients with blastomycosis. Routine use of reference sera containing the A and B precipitins in immunodiffusion tests would permit the specific diagnosis of blastomycosis without the need for parallel tests with coccidioidin and histoplasmin.

Antigens, Fungal↗

PubMed1986

Diagnostic assessment of an enzyme-linked immunosorbent assay for human and canine blastomycosis.

An enzyme-linked immunosorbent assay (ELISA) for blastomycosis was evaluated with 65 human sera from culturally or histologically proven cases of blastomycosis, 53 sera from humans with heterologous infections, and 115 sera from apparently normal people. The diagnostic value of the ELISA was compared with that of the widely used complement fixation (CF) and immunodiffusion (ID) tests. The assay gave a sensitivity of 80% and a specificity of 98% with a minimal positive titer of 1:16. In contrast, the CF and ID tests demonstrated sensitivities of only 40 and 65%, respectively, and both were 100% specific. It was concluded that ELISA titers of 1:32 or greater are indicative of active blastomycosis, whereas lower titers, which might represent cross-reactions, were considered suggestive of the disease. The specificity of low titers should be confirmed by immunodiffusion tests or from the study of serial serum specimens. Preliminary studies with sera from 6 dogs with active blastomycosis and 31 asymptomatic dogs revealed an ELISA sensitivity of 100% and a specificity of 97% when a 1:8 cutoff titer was used. Although a wide range of titers was obtained in both human and canine specimens, no single titer could be relied on to reflect the clinical form of disease. However, a four-fold-or-greater reduction in titer for serial specimens appeared indicative of a favorable prognosis.

Animals↗

PubMed1984

Pulmonary blastomycosis: radiologic manifestations.

Blastomycosis, an airborne fungal disease with the lung the portal of entry, is endemic to the central and south central areas of the United States. The disease occurs in patients who range from asymptomatic to those with symptoms of acute pneumonia. Retrospective review of 27 cases from our institution revealed four well-defined radiographic patterns including air-space disease, nodular masses, interstitial disease, and cavitation. Some patients with air-space disease have symptoms of an acute pneumonia; more commonly they have no pulmonary symptoms. Air-space disease was the most frequent radiographic pattern in chronic blastomycosis with proved nonpulmonary disease; therefore, it cannot be regarded as indicative of early or acute blastomycosis. There was no relationship between the radiographic pattern and distribution, pulmonary symptomatology, or clinical stage of the disease. Our material does not support the previously suggested association of lower lobe air-space disease with early disease and upper lobe involvement with the chronic and often disseminated form. A more precise understanding of the variety of radiographic patterns and the spectrum of clinical presentations will facilitate diagnosis of pulmonary blastomycosis.

Adolescent↗

PubMed1982

Blastomycosis in immunosuppressed patients.

Of 78 patients with blastomycosis, 3 patients had received glucocorticoid therapy prior to diagnosis and 3 others had an underlying hematologic malignancy (chronic lymphocytic leukemia, chronic myelogenous leukemia, multiple myeloma). The clinical picture in these 6 patients was similar to blastomycosis in nonimmunosuppressed patients (in contrast to histoplasmosis or coccidioidomycosis in immunosuppressed patients in whom a distinct clinical syndrome is often seen). The patients presented with chronic pulmonary infiltrates or with isolated skin ulcers. The response to therapy was good if the diagnosis was made early. Blastomycosis can occur in immunosuppressed patients. However, the spectrum of underlying illness is not that seen in opportunistic histoplasmosis or coccidioidomycosis, where patients with T-cell defects predominate. Possible explanations for the rarity of blastomycosis in more classically T-cell-immunosuppressed patients are discussed.

Adult↗

PubMed1993

Blastomycosis in otolaryngology: review of a large series.

Blastomycosis is a fungal disease whose signs, symptoms, and roentgenographic findings may suggest pneumonia, cancer, tuberculosis, or other fungal infections. Blastomycosis has a variable clinical course; it primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. To determine the frequency of head and neck manifestations, we reviewed the records of patients with blastomycosis seen at the Mayo Clinic from 1960 to 1990 and found that involvement of the skin and mucosal surfaces, including the larynx, was common. Gross and histopathologic features of the lesions often resemble those of well-differentiated squamous cell carcinoma; thus, overly aggressive therapy may be mistakenly instituted. The clinical features, morphologic findings, and diagnosis of blastomycosis are discussed, and the importance of obtaining and handling specimens correctly is emphasized.

Blastomycosis↗

PubMed1997

Update and review of blastomycosis.

Blastomycosis has a wide spectrum of clinical presentations. When a patient presents with chronic pneumonia, especially coexisting with cutaneous lesions, blastomycosis infection needs to be considered in the differential diagnosis. Erythema nodosum can rarely be associated with pulmonary blastomycosis. A positive culture is the gold standard of diagnosis; occasionally, the organism can be identified by its typical "shoe print" morphology with periodic acid-Schiff (PAS) stain. The Gen-Probe technique may be required to confirm the uncertain culture results. The preferred treatment for blastomycosis in less severe cases is oral itraconazole, with amphotericin B in disseminated cases.

Adult↗

PubMed2000

Novel cases of blastomycosis acquired in Toronto, Ontario.

Blastomycosis a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.

Adult↗

PubMed2001

[Cutaneous blastomycosis revealing a corticoadenoma].

BACKGROUND: Blastomycosis is an uncommon chronic granulomatosis caused by Blastomyces dermatitidis. We present a case with a skin localization that disclosed malignant corticoadenoma. CASE REPORT: A 32-year-old man consulted for inflammatory nodules of the face and lower limbs. The histological examination of a nodule biopsy was in favour of blastomycosis. Ketoconazole treatment was ineffective. Amphotericin B provided cure of the skin lesions. Search for extension disclosed a malignant corticoadrenoma. DISCUSSION: Blastomycosis is very rare in Morocco. The portal is usually the lung. Unique skin involvement is very exceptional. To our knowledge this is the first report of a blastomycosis-corticoadenoma association. The clinical situation may be alarming in immunodepressed subjects. Amphotericin B treatment is indicated.

Adrenal Cortex Neoplasms↗