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PubMed1984

Blastomycosis during pregnancy.

Disseminated blastomycosis with extensive involvement of the lungs, skin and bones was diagnosed in a 31-year-old woman who was 36 weeks pregnant. No antifungal treatment had been given while she was pregnant, and she gave birth shortly after admission to hospital. The child was healthy and uninfected, and there were no signs of inflammation or infection in the placenta. Post partum the mother was treated with 2 g of amphotericin B, with resolution of her symptoms. A literature review suggested that blastomycosis and other systemic fungal infections are more likely to occur during pregnancy because of immunosuppression and that disseminated blastomycosis in pregnant women should be treated with amphotericin B.

Adult↗

PubMed1980

Evaluation of the agar-gel immunodiffusion test in the diagnosis of canine blastomycosis.

The agar-gel immunodiffusion test was used to evaluated 35 dogs with histopathologically confirmed blastomycosis and 98 dogs without blastomycosis. The test had a sensitivity of 91% and a specificity of 96%. Thirteen of the dogs treated for blastomycosis were tested at 6 to 33 months after treatment with amphotericin B. Ten of 13 dogs became seronegative and 3, though clinically normal, remained seropositive at 19, 20, and 20 months, respectively, after amphotericin treatment.

Amphotericin B↗

PubMed1982

Ocular lesions of blastomycosis in the dog.

Twenty-one dogs with ocular disease and blastomycosis were studied clinically. The most common ocular lesion was uveitis. Other findings included retinal separation, panophthalmitis, and glaucoma. The results of the study indicated that when uveitis is found in dogs in central United States, east of the Mississippi River, blastomycosis should be a diagnostic consideration. When the uveitis was associated with lung, lymph node, skin, bone, or testicular lesions, the likelihood of blastomycosis was greater.

Animals↗

PubMed1995

Blastomycosis: pulmonary and pleural manifestations.

Seven diverse cases of pulmonary blastomycosis were recently diagnosed at this institution. It is our purpose to review the unique features in the spectrum of this systemic illness as illustrated by these cases. The wide range of radiographic findings included parenchymal disease, mass-like lesions, and pleural effusions. One patient had endobronchial blastomycosis. Although significant pleural effusions have been uncommonly reported, we note this finding in two of our seven cases. Both of these patients had thoracentesis, which yielded markedly elevated pleural fluid total protein. These seven cases emphasize the marked variability of pulmonary and pleural blastomycosis.

Adult↗

PubMed1995

A case report of disseminated blastomycosis and adult respiratory distress syndrome.

Blastomycosis is a fungal disease endemic to the midwestern and southeastern United States. This is a case report of a 29-year-old woman who presented with weight loss, fever, fatigue, and pneumonia. She developed disseminated blastomycosis, adult respiratory distress syndrome (ARDS), and ulcerative skin lesions, requiring mechanical ventilation, amphotericin B, and multiple surgeries. Blastomycosis is endemic to a large portion of the United States. Family physicians should consider fungal infection in the differential diagnosis of an unresolving pneumonia.

Adult↗

PubMed1994

Acute miliary blastomycosis in an AIDS patient.

The incidence of blastomycosis in immunocompromised patients with HIV infection is very low when compared to other mycoses. Of the 19 cases of blastomycosis described in HIV-infected patients, only four had a miliary pattern on chest x-ray. A case of acute miliary blastomycosis in an HIV infected patient from Louisville is described.

Acquired Immunodeficiency Syndrome↗

PubMed1977

North American blastomycosis in South Africa: a case report.

Blastomycosis dermatiditis, or North American blastomycosis, is rarely encountered in the Republic of South Africa. In view of the increasing number of reports of this disease from other parts of Africa and the rest of the world, one wonders whether North American blastomycosis is not a misnomer. It should perhaps be included in the differential diagnosis, particularly in cases of refractory skin ulceration.

Blastomycosis↗

PubMed1997

Endemic blastomycosis in Mississippi: epidemiological and clinical studies.

In order to clarify the epidemiology and clinical spectrum of endemic blastomycosis, we reviewed the charts of 326 culture and/or histologically proven cases of blastomycosis in Mississippi from 1979 to 1988. Cases were dispersed throughout the state, but counties in central and south-central Mississippi reported 63% of all blastomycosis cases. The average annual incidence rate was 1.3 cases per 100,000 population. The majority of cases were in men (male to female ratio 1.7:1), and most patients were aged in their third through seventh decades (82%). Outdoor occupations were noted for only 28.9% of cases. Cases occurred throughout the year with no significant seasonal peak. Although 55% saw a physician within 7 days of onset of illness, 29% presented after 1 month. Despite early presentation, diagnosis was often delayed for more than 1 month (43.3%). Single organs were involved in 82.8% of cases. For all cases, organ systems involved included lungs (91.4%), skin (18.1%), bone (4.3%), genitourinary system (1.8%), and central nervous system (1.2%). The presence of skin or bone disease was associated with multiorgan involvement. Thirty-three patients died (11.5%), 6 of whom received no therapy. Patients who died were significantly older than those who survived. A successful outcome without relapse was noted in 86.5% of amphotericin B-treated patients and in 81.7% of ketoconazole-treated patients. The relapse rate for ketoconazole-treated patients was higher than for amphotericin B-treated patients (14% and 3.9% respectively).

Adolescent↗

PubMed1997

Blastomycosis in the immunocompromised patient.

Blastomycosis has become increasingly recognized as a serious infection in immunocompromised hosts in recent years. Underlying disorders among these patients include conditions that are typically characterized by abnormalities of T-lymphocyte function such as acquired immunodeficiency syndrome, long-term glucocorticosteroid use, hematologic malignancy, solid organ transplantation, and pregnancy, in addition to a variety of other diseases. Clinically, the disease in immunocompromised patients is potentially much more severe and is characterized by disseminated multiple organ involvement including frequent involvement of the central nervous system. Adult respiratory distress syndrome and/or miliary pulmonary involvement, relatively rare complications in the normal population, are also common in immunocompromised patients. Most notably, mortality as a result of blastomycosis in these patients exceeds 30% and usually occurs within several weeks of presentation. Because of the severity of the disease, initial therapy with amphotericin B is advised for most immunocompromised patients with blastomycosis to gain control of the disease. The role of itraconazole as initial therapy is probably limited to patients with focal, uncomplicated disease. Many of these patients, particularly those with conditions associated with ongoing immunosuppression, require chronic suppressive therapy with an azole to prevent relapsing disease.

AIDS-Related Opportunistic Infections↗

PubMed1998

Epidemiology of human blastomycosis in Vilas County, Wisconsin. II: 1991-1996.

PURPOSE: A previous report identified Vilas County, Wisconsin, as an area highly endemic for blastomycosis based on a case series 1979-90. This study was done to compare the epidemiologic features of persons with this disease over the following six years. METHODS: Compilation of data from the 47 mandatory physician/laboratory case reports of blastomycosis, disease onset 1991-96, received at the Vilas County Health Department; case mapping by site visit; and statistical comparison to the previous series. RESULTS: The estimated mean annual incidence rate for Vilas County during 1991-96, 40/100,000, remains unchanged from 1984-90. Cases were again disproportionately represented in the southeast corner of the county, and 36/46 lived within 1/4 mile of water. There was a trend toward a higher proportion of female cases in this study (27/47) compared to the prior report (28/73; P = 0.06); the mean age, 47 years, did not differ. Among 32 patients whose activities were recorded, a minority engaged in hunting (4), fishing (4) and gardening (12) prior to disease onset; but 19/32 recalled excavation prior to exposure compared to 17/60 in 1979-90 (P < 0.01). Among cases with a pulmonary presentation, winter onset cases (3/40) were significantly fewer than in 1979-90 (19/55). However, over the entire 18 years there was no disproportionately represented season. CONCLUSIONS: In highly endemic Vilas County, the mean annual incidence of human blastomycosis appears stable over the past 13 years. A combined case series of 18 years reveals no predilection by gender or season of onset.

Adolescent↗

PubMedDate not supplied

Blastomycosis. Report of a case with noninvasive, rapid diagnosis of dermal lesions by the Papanicolaou technique.

BACKGROUND: Blastomycosis is a rare fungal infection that occurs most often in young to middle-aged men. A common route of infection is through continued contact with soil, occurring in such occupations as gardening and construction work. The skin and lungs are primarily affected. When the respiratory system is involved, blastomycosis may be misdiagnosed as pulmonary miliary tuberculosis. CASE: A 54-year-old, African American male presented with dry cough and multiple verrucous skin lesions affecting the face, shoulder and legs. Chest roentgenography indicated bilateral lung involvement. The patient died following a short, difficult hospital course. Autopsy revealed verrucous skin lesions with dry, thick, raised margins and central necrosis and umbilication, and severe, diffuse pulmonary involvement clinically and radiologically, resembling miliary tuberculosis. A smear from a leg ulcer stained by the Papanicolaou technique revealed fungi within the giant cells. CONCLUSION: Clinical and radiologic findings alone do not establish the diagnosis of blastomycosis. Respiratory involvement may lead to a misdiagnosis of pulmonary miliary tuberculosis. Sputum and bronchial washing examinations by a laboratory technique are in order. This case indicates that cytologic examination of the exudate from an ulcer may result in a strongly suggestive diagnosis.

Blastomyces↗

PubMed1979

Pulmonary blastomycosis in children. Amphotericin B therapy and a review.

Two children, aged 3 months and 4 years, respectively, were treated with ten weeks of amphotericin B for culture proved pulmonary blastomycosis. Organisms were easily demonstrated in nasopharyngeal or sputum specimens on admission. Although organisms were present until the 12th and 19th days of therapy, respectively, they were viable through only the seventh and 12th days of therapy. Both patients had thrombophlebitis, anemia, neutropenia, hypokalemia, fever, and vomiting develop during therapy. The less toxic drug hydroxystilbamidine isethionate, given for only 17 to 30 days, has been used successfully in at least six previously reported cases. Long courses of amphotericin B therapy may not be necessary for the treatment of pulmonary blastomycosis in selected children.

Amphotericin B↗

PubMed1977

Disseminated North American blastomycosis. Occurrence with clinical manifestations of adrenal insufficiency.

Adrenal involvement in cases of disseminated North American blastomycosis occurs frequently, but clinically substantive adrenal insufficiency is rare. An unusual case of disseminated blastomycosis with clinical manifestations of adrenal insufficiency was found. One should be alert to the symptoms of adrenal insufficiency that may develop in patients with disseminated mycoses.

Abscess↗

PubMed1993

Reactivation and dissemination of blastomycosis complicating Hodgkin's disease: a case report and review of the literature.

Patients presenting with Hodgkin's disease (HD) may show lung involvement characterized by contiguous spread from ipsilateral hilar lymph nodes. Lung consolidation or noncontiguous pulmonary involvement makes an alternative diagnosis more likely. This report describes a patient with HD in whom concurrent pulmonary blastomycosis was recognized only after chemotherapy had started and dissemination had occurred. Although Blastomyces dermatitidis may behave as an opportunist pathogen, there are no previous reports of blastomycosis in patients with HD. Undiagnosed active opportunistic infection at the time of diagnosis of HD may complicate staging as well as treatment. Biopsy of lung lesions with stain and culture for opportunistic pathogens should be considered in patients with newly diagnosed HD disease and atypical patterns of lung involvement.

Adult↗

PubMed1978

The spectrum of primary blastomycotic meningitis: a review of central nervous system blastomycosis.

Three cases of meningitis with initial and exclusive neurological involvement prompted a review of the clinical, cerebrospinal fluid, and pathological findings in an additional 78 patients with central nervous system blastomycosis. The first patient of the 3 had progressive cerebellar dysfunction as the result of chronic basilar meningitis. The second had a C8-T1 radiculopathy without other evidence of superior sulcus syndrome, and subsequent acute fatal meningitis. The third had aseptic, benign, self-limited meningitis followed by clinically obvious systemic blastomycosis. Diagnosis is difficult, and it is likely that other cases have been presumptively treated for tuberculous meningitis. A more aggressive approach to diagnosis is proposed that takes into account the condition of the patient, the likelihood of dissemination at necropsy, and the frequent meningeal infections that are negative on culture of lumbar CSF.

Adult↗

PubMed1987

Gallium-67 imaging in the diagnosis of blastomycosis.

67Ga imaging was used in a group of 13 untreated patients with documented South American blastomycosis in an attempt to obtain additional information on the site and extent of the lesions. All diagnoses were confirmed by demonstration of the fungi in the lesions or body fluids. Serologic tests were performed on all patients. 67Ga imaging was correlated with X-ray in all patients, and with bone imaging when bony lesions were suspected. 67Ga imaging was positive for all lesions detected on chest X-ray and by clinical evaluation. More importantly, lesions clinically unsuspected and missed by other diagnostic techniques were shown on 67Ga imaging: bony and hepatic lesions in three patients; a brain lesion in one patient and parotid gland involvement in five patients. There was good agreement between 67Ga imaging and clinical and laboratory data, scintigraphy being more sensitive. Follow-up studies after specific therapy demonstrated decreased uptake in the lungs and other sites. 67Ga imaging is a useful tool for detection of suspected and unsuspected lesions of blastomycosis and to evaluate the response of the disease to specific therapy.

Adult↗

PubMed1991

An outbreak of blastomycosis in eastern Tennessee.

Most cases of blastomycosis are sporadic and only nine outbreaks representing a total of 112 cases have previously been reported. Less than half of these have been culture proven cases. Outbreaks have previously occurred in North Carolina, Minnesota, Illinois, Wisconsin and Virginia. We report three culturally confirmed cases of blastomycosis from Elizabethton, Tennessee, who had onset of illness within a one-week span of time. The patients presented with fever, chest pain, weight loss, poor appetite and myalgia. Each initially had a dry cough which became productive of purulent sputum as the illness progressed. Mild hemoptysis occurred during each patient's course. Serologic testing by immunodiffusion and enzyme immunoassay were positive and testing by complement fixation was negative in each case. The diagnosis was made by histopathology on transbronchial biopsy or transthoracic needle aspiration material. Each patient improved on ketoconazole therapy.

Adult↗

PubMed1984

Immunohistopathological studies of blastomycosis: the use of labeled specific antigens in a hamster model of disease.

We applied a modified immunofluorescence and immunoperoxidase method, utilizing labeled Blastomyces dermatitidis antigens, to look for specific antibody-bearing B/plasma cells in the tissue infiltrates of blastomycosis lesions induced in hamsters. No specific anti-blastomyces antibodies were detectable by this method, although such antibodies were present in blood samples as demonstrated by routine immunodiffusion techniques. These studies suggest that humoral immune reactions do not play a major role in the pathogenesis of lesions of blastomycosis in hamsters.

Animals↗