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PubMed2004

[Cutaneous blastomycosis: description of two cases in Tunisia].

Blastomycosis is an uncommon mycotic infection in Africa. Isolated cutaneous disease is extremely rare. The purpose of this report is to describe 2 cases of cutaneous blastomycosis. The first case Involved a 70-year-old rural woman who presented papulonodules associated with scars on the upper extremities and right leg, ongoing for 2 months. The second patient was a 47-year-old woman who presented 2 vegetating plaque areas above the left knee and on the left shoulder, ongoing for 4 months. In addition a bow-shaped scar resulting from a dog bite was observed. Histologic examination and culture on Sabouraud's medium and brain heart agar confirmed diagnosis of cutaneous blastomycosis in both patients. No visceral involvement was found. Blastomycosis is uncommon in Tunisia with only 6 previously published cases. The two cases reported here are interesting because involvement was confined to the skin suggesting cutaneous inoculation of Blastomyces dermatitidis.

Aged↗

PubMed2006

Pulmonary blastomycosis masquerading as metastatic disease in the lung: a case report.

We report a case of pulmonary blastomycosis appearing as metastatic laryngeal squamous cell carcinoma. Pulmonary blastomycosis was discovered as right lower lobe subpleural activity consistent with metastatic disease on a positron emission tomographic (PET) scan following total laryngectomy and bilateral neck dissection for locally invasive laryngeal squamous cell carcinoma. A computed tomographic (CT) scan of the chest showed a right lower lobe, subpleural pulmonary nodule. CT-guided fine-needle aspiration of the nodule revealed broad-based budding yeast consistent with blastomycosis. To our knowledge, this is the first case of a PET-positive pulmonary blastomycosis lesion mimicking pulmonary malignancy reported in the literature.

Aged↗

PubMed2006

Northern Wisconsin married couple infected with blastomycosis.

Blastomycosis is an uncommon, chronic, granulomatous disease caused by the dimorphic fungus Blastomycosis dermatitidis. The great majority of infections start with primary pulmonary involvement through inhalation of spores. Hematogenous dissemination to other sites occurs in 25% to 30% of cases. The most common secondary site is the skin, followed in order by bone, genitourinary system, and central venous system. We report 2 cases of blastomycosis originating in a husband and wife who were both symptomatic and diagnosed with blastomycosis within 4 months of each other. One presented with pulmonary symptoms, the other with cutaneous symptoms. These 2 cases of husband and wife are of interest not only because of their rarity but also because of the potential mode of transmission.

Antifungal Agents↗

PubMed1987

Blastomycosis in a patient with psoriasis: treatment with ketoconazole.

Slowly enlarging verrucous skin lesions occurred in a 42-year-old man with psoriasis after he received systemic steroid treatment. Examination of skin biopsy specimens established the diagnosis of blastomycosis. Extensive evaluation revealed no other organ system involvement. The lesions of blastomycosis responded well to ketoconazole therapy; the psoriasis was unaffected. This report reviews the natural history of blastomycosis, speculates on the patient's immune status at the time of infection, and comments on the use of ketoconazole in the treatment of blastomycosis and psoriasis.

Adult↗

PubMed1986

Self-limited blastomycosis: a report of 39 cases.

We report 39 patients with pulmonary blastomycosis who were not treated with specific antifungal chemotherapy. Fourteen of these patients were recognized during an epidemic of blastomycosis in 1972 and did not have culturally proven disease. The remaining 25 patients were all proven instances of blastomycosis, 24 of whom had pulmonary disease only. Over a median observation period of 42 months (range: 12 to 168) one patient relapsed 52 months after the original diagnosis, while all of the others have remained clinically well. It is our belief that certain patients with blastomycosis limited to the lungs may safely be followed without specific antifungal chemotherapy until clearing occurs. These include patients with mild or no symptoms and those who have been more symptomatic but are already improving when the diagnosis is established. Worsening of the clinical picture, or evidence of extrapulmonary disease requires immediate antifungal chemotherapy.

Adolescent↗

PubMed1979

Blastomycosis-like pyoderma.

Seven patients with blastomycosis-like pyoderma had skin lesions of four months' to six years' duration. The criteria for the diagnosis of blastomycosis-like pyoderma include the clinical presentation of large verrucous plaques with multiple pustules and elevated border, pseudoepitheliomatous hyperplasia with abscess histologically, and the growth of at least one pathogenic bacteria from the culture of a tissue-biopsy specimen. The differential diagnosis includes deep fungus infection (especially North American blastomycosis), bromoderma, pyoderma gangrenosum, mycobacterial infections, giant keratoacanthoma, and squamous cell carcinoma. Generally, the patients had one or more conditions that could have affected their systemic or local immunologic competence to infection. We believe that the clinical and histologic features in these cases of blastomycosis-like pyoderma were produced by an unusual, exaggerated, vegetating-tissue reaction to a primary or secondary bacterial infection.

Adult↗

PubMed1982

Immunologic changes in acute canine blastomycosis.

Immunologic evaluations were done on a total of 21 dogs presented with acute blastomycosis. There were significant increases in serum alpha 2-, beta-, and gamma-globulins with decreases in albumin concentration. Serum immunoglobulin G was significantly increased, while immunoglobulin M was decreased. Lymphocyte reactivity was evaluated in 6 dogs with acute blastomycosis. There were significant reductions in lymphocyte reactivity in autologous sera to pokeweed, concanavalin, and phytohemagglutinin stimulation. In addition to decreased reactivity of lymphocytes in dogs with normal lymphocyte counts, 40% of dogs with acute blastomycosis were lymphopenic. Abnormalities in cell-mediated immunity may have a role in the pathogenesis of canine blastomycosis.

Acute Disease↗

PubMed1983

Counterimmunoelectrophoresis (immunoelectroosmosis) and serum electrophoretic pattern in serologic diagnosis of canine blastomycosis.

Counterimmunoelectrophoresis (CIEP) with blastomyces and histoplasma antigens was used in a serologic study of 181 dogs clinically suspected of having blastomycosis and of 8 dogs with confirmed blastomycosis or histoplasmosis. Thirteen of the 181 dogs, positive by CIEP, were euthanatized, and the diagnosis was confirmed by cultivation and/or microscopic detection of Blastomyces dermatitidis. Additional CIEP-positive dogs were confirmed by staining of aspirates collected in vivo. Radiographic support for the diagnosis was reported in 4 other dogs in which histoplasmosis was excluded by a negative CIEP with histoplasma antigen. The precipitating antibody may disappear during the course of the disease, as it did in 1 dog treated with amphotericin B, but not cured. This dog reverted from CIEP-positive to CIEP-negative within 17 months of treatment (with a weak reaction after 10 months of treatment). The CIEP-detectable antibody was present only in 1 dog without a confirmation by histopathologic findings or cultivation among 24 well-documented cases and 181 total tested sera. The CIEP was more sensitive and specific than was the gel-diffusion precipitin test, eliminated the problems of anticomplementarity that often affected the results of complement-fixation tests with canine sera, and served well in detecting dogs with blastomycosis. Electrophoretic pattern of sera from CIEP-positive dogs with blastomycosis showed a decrease in albumin and an increase in alpha 2- and often in beta- and gamma-globulins, with a substantial decrease of the albumin/globulin ratio.

Animals↗

PubMedDate not supplied

Blastomycosis in a Papanicolaou Smear. Report of a case with possible venereal transmission.

An incidental case of cervical blastomycosis discovered by examination of a Papanicolaou smear is reported. Examinations revealed no other focus of blastomycosis in the patient. Since her husband was undergoing treatment for disseminated blastomycosis involving the lungs and prostate at the time the fungus was found, this case may represent venereally transmitted blastomycosis.

Blastomycosis↗

PubMed1982

Erythema nodosum and blastomycosis.

Two patients with blastomycosis and erythema nodosum are described. In one patient, the underlying blastomycosis resolved after wedge resection of the pulmonary infiltrate, but without chemotherapy. In the second patient, the underlying disseminated blastomycosis required amphotericin B therapy. Blastomycosis should be included in the differential diagnosis of erythema nodosum.

Aged↗

PubMed1995

Choroidal blastomycosis. A report of two cases.

PURPOSE: To review the presentation and course of choroidal blastomycosis, a rare chorioretinal mycotic infection, which results from disseminated blastomycosis. METHODS: Two cases of disseminated blastomycosis with ocular infection limited to the choroid are presented. Each patient was diagnosed through biopsy of skin lesions demonstrating the characteristic histologic features and the budding yeast. RESULTS: Systemic evaluation revealed extensive disseminated disease with involvement of the eye, lung, skin, bone and joint, central nervous system, and genitourinary system. Both patients were successfully treated with intravenous amphotericin B with elimination of ocular and systemic disease. CONCLUSION: Although rare, blastomycosis can result in choroidal mycotic infection in immune competent individuals. Tissue biopsy to confirm the diagnosis and extensive systemic evaluation are required.

Adult↗

PubMed1996

Blastomycosis--Wisconsin, 1986-1995.

Blastomycosis is a disease of humans and animals caused by inhalation of airborne spores from Blastomyces dermatitidis, a dimorphic fungus found in soil. The spectrum of clinical manifestations of blastomycosis includes acute pulmonary disease, subacute and chronic pulmonary disease (most common presentations), and disseminated extrapulmonary disease (cutaneous manifestations are most common, followed by involvement of the bone, the genitourinary tract, and central nervous system). Although the disease is not nationally notifiable, it was designated a reportable condition in Wisconsin in 1984 following two large outbreaks. This report summarizes information about cases of blastomycosis reported in Wisconsin during 1986-1995 and highlights the importance of surveillance for blastomycosis in areas with endemic disease.

Adolescent↗

PubMed1996

Ocular blastomycosis in dogs: 73 cases, 108 eyes (1985-1993).

OBJECTIVE: To evaluate clinical signs of ocular blastomycosis in dogs, to determine response of blastomycosis-infected eyes to treatment with systemically administered amphotericin B and ketoconazole, and to identify prognostic indicators of successful antifungal treatment. DESIGN: Retrospective study. ANIMALS: 73 dogs. PROCEDURE: Medical records were reviewed for all dogs with confirmed blastomycosis and ocular disease seen at our hospital between 1985 and 1993. RESULTS: 6 eyes had anterior segment disease, 24 had posterior segment disease, and 78 had endophthalmitis. 40 eyes were treated with a combination of amphotericin B and ketoconazole, and 16 of the 40 responded favorably. However, 16 of the 24 eyes that were not severely affected responded favorably, but none of the 16 eyes that were severely affected did. CLINICAL IMPLICATIONS: Dogs with blastomycosis had posterior segment disease, without complete retinal separation, had a good prognosis for retaining vision. Results of histologic examination suggested that secondary glaucoma was a manifestation of endophthalmitis and was indicative of a grave prognosis for response to antifungal and antiglaucoma treatment.

Amphotericin B↗

PubMed1997

Epidemiological and clinical features of pulmonary blastomycosis.

The epidemiological and clinical aspects of Blastomycosis are reviewed. The central United States is the most heavily endemic area in the world, although the extent of the endemic zone has been mapped only by individual case finding, rather than by large skin test surveys (as was done for histoplasmosis). The difficulties in developing a sensitive and specific skin test antigen are reviewed, and the sequence of antigens from Blastomycin to antigen A to the ASWS (alkali and water soluble) antigen to the WI (Wisconsin) antigen are discussed. The absence of good immunological markers of remote subclinical disease means that the size of the iceberg of subclinical cases relative to clinically apparent and diagnosed pulmonary and extrapulmonary cases remains uncertain. Clinical presentations of blastomycosis range from (1) asymptomatic, currently discovered only in outbreak situation, (2) flulike illness of brief duration resembling other upper respiratory infections, (3) illness resembling bacterial pneumonia with acute onset, high fever, lobar infiltrates, and productive cough, (4) subacute or chronic respiratory illness with symptom complex resembling tuberculosis or lung cancer and radiographic presentation of fibronodular infiltrates or mass-like lesions, and (5) fulminant infectious adult respiratory distress syndrome (ARDS) with high fever, diffuse infiltrates, and progressive respiratory failure. Radiographic presentations are highly variable and even more confusing because of lack of standard terminology to describe these abnormalities. Examples of some of the radiographic presentations of blastomycosis are shown. Available information concerning computed tomographic studies is also reviewed. Special mention is made of blastomycosis in AIDS, which is uncommon but tends to be fulminant, systemic, and rapidly progressive. An overview of current diagnostic strategies and treatment options is also presented.

AIDS-Related Opportunistic Infections↗

PubMed2004

Blastomycosis.

Blastomycosis is an endemic fungal infection predominantly seen in the south central and mid-western United States and portions of Canada. The disorder is caused by Blastomyces dermatitidis, a dimorphic organism usually acquired through inhalation of aerosolized conidia. Most acutely infected patients are asymptomatic or develop a self-limited respiratory illness. Chronic pneumonia is the dominant clinical manifestation of blastomycosis, although extrapulmonary disease is common, usually involving skin and subcutaneous tissue, bones and joints, the prostate gland, and the central nervous system (CNS). Chronic blastomycosis should always be treated with systemic antifungal therapy, and oral itraconazole is the drug of choice for mild to moderate forms of the disease. Severe manifestations, including adult respiratory distress syndrome, CNS involvement, and disease in severely immunocompromised hosts require primary therapy with an amphotericin B formulation. There are no routine measures to prevent blastomycosis, although there is promising experimental data involving the use of a live, attenuated vaccine.

Journal Article↗

PubMed1985

Blastomycosis presenting as monoarticular arthritis. The role of synovial fluid cytology.

Joint complaints are common among patients with blastomycosis; however, true arthritis is infrequently documented by synovial fluid analysis. Of 72 individuals with blastomycosis who were patients at the Vanderbilt School of Medicine affiliated hospitals during the period 1957-1983, 6 (8%) had arthritis at presentation. In 5 patients (7%), monoarticular arthritis was the chief complaint leading to hospitalization. Cytologic examination of synovial fluid was performed in 4 patients and demonstrated characteristic organisms each time. Three patients had negative 10% potassium hydroxide smears, and 2 had negative synovial fluid cultures. Blastomycosis should be considered in the differential diagnosis of acute arthritis. In patients with blastomycotic arthritis, cytologic examination of synovial fluid can add to the diagnostic yield of synovial fluid fungal cultures and potassium hydroxide preparations.

Adolescent↗

PubMed1993

IL-4, IgE, and interferon-gamma production in pulmonary blastomycosis: comparison in mice untreated, immunized, or treated with an antifungal (SCH 39304).

The purpose of this study was to determine if there is a correlation between production of certain lymphokines in progressive blastomycosis in untreated mice, resistance to infection in immunized mice, and cure in antifungal triazole (SCH 39304)-treated mice. Infection was measured by colony-forming units of Blastomyces dermatitidis in lungs. Serum level of IgE was used as a marker for in vivo IL-4 activity. Serum IgE levels rose in untreated mice from 6 micrograms/ml at 3 weeks to 24 micrograms/ml by the fourth week as their infection progressed. This corresponded to a peak in vitro production of IL-4 (147 pg/ml) by antigen-stimulated spleen cells at Week 4. By contrast, there was an inverse relationship between serum IgE- and antigen-stimulated production of IFN-gamma in vitro, e.g., 80 U/ml at the third week and 4 U/ml at Week 4. In mice undergoing cure with SCH 39304, serum IgE decreased from 12 micrograms/ml at the third week to 2 micrograms/ml at Week 4. This correlated with a drop in IL-4 and an increase in IFN-gamma production in in vitro assays. As cure proceeded over the next 4 weeks, IgE and IFN-gamma measurements were near background levels. In immunized mice a low-grade chronic blastomycosis emerged after 3 weeks of infection. Chronic infection was associated with inverse cycles of elevated IgE in serum and IFN-gamma production as assayed in vitro. IL-4 production cycled directly with increased IgE levels in serum. Although spleen cells from untreated mice produced IFN-gamma and IL-4 when stimulated with antigen, they did not mount significant proliferative responses. By contrast, spleen cells and lymph node cells from immunized and SCH 39304-treated mice made good proliferative responses to antigen and this correlated with resistance and clearing of the infection, respectively. These data indicate that in pulmonary blastomycosis, serum IgE levels correlate directly with IL-4 and inversely with IFN-gamma production. Clearing of the infection by the antifungal agent SCH 39304 reduces lymphokine production to background levels but sensitizes lymphocytes for proliferative responses to antigen.

Animals↗

PubMed1979

Blastomycosis: report of three cases from Alberta with a review of Canadian cases.

Approximately 120 cases of blastomycosis have been reported from Canada to-date. The great majority of these occurred in the Eastern provinces. Since 1970, three cases of blastomycosis have been seen in Alberta. The first case, with meningeal and pulmonary involvements, was diagnosed at post-mortem. The second case was that of a 75-year-old male with a history of pancytopenia, aortic arteriosclerosis, exposure to mercury, and fever. KOH and periodic-acid schiff (PAS) stained smears of the lung tissue, received after autopsy, showed numerous budding yeast cells of Blastomyces dermatitidis along with some hyphal filaments. Similarly, budding cells of B. dermatitidis and hyphal segments were observed in large numbers in the PAS and Gomori's methenamine-silver (GMS) stained sections made from adrenals, lung, kidney, and spleen tissues. Attempts to culture the fungus on a variety of selective and non-selective media were unsuccessful, due to heavy bacterial contamination. The indirect fluoroscent antibody results were 2+ with the B. dermatitidis conjugate. The third case was that of a 31-year-old male, who was admitted to the hospital with the chief complaint of chest pain. Biopsy tissue sections, stained with the GMS procedure revealed a few foci with B. dermatitidis yeast cells. The immunodiffusion and complement fixation (CF) tests gave positive results against B. dermatitidis antigen (titre, 1:16). The CF titre declined following treatment with amphotericin B and the immunodiffusion test became negative after the institution of antifungal therapy. Except for the last patient, the other two patients had no history of travel in any known endemic areas. In addition to these cases, a survey of blastomycosis occurring in this country has been presented along with on the disease in dogs and a cat.

Adolescent↗