Blastomyces dermatitidis
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Blastomycosis

Blastomycosis is a fungal infection caused by the organism Blastomyces dermatitidis more...

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History

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

Epidemiology

In the US:

  • Most cases of blastomycosis occur in the United States. It 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, Kentucky, Arkansas, and Wisconsin.

In Canada:

  • Most cases of blastomycosis in Canada occur in northwestern Ontario, in particular, around the Kenora area. The moist, acidic soil in the surrounding woodland harbours the fungus.

Internationally:

  • Blastomycosis is distributed throughout the world. Cases are sometimes reported from Africa.

Pathophysiology

Infection occurs by inhalation of the fungus from its natural soil habitat. Once inhaled in the lungs, they multiply and may disseminate through the 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.

Features

Blastomycosis can present in one of the following ways:

  • a flulike illness with fever, chills, myalgia, headache, and a nonproductive cough which resolves within days.
  • an acute illness resembling bacterial pneumonia, with symptoms of high fever, chills, a productive cough, and pleuritic chest pain.
  • a chronic illness that mimics tuberculosis or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, and weight loss.
  • a fast, progressive, and severe disease that manifests as ARDS, with fever, shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates.
  • skin lesions, usually asymptomatic, appear as ulcerated lesions with small pustules at the margins
  • bone lytic lesions can cause bone or joint pain.
  • prostatitis may be asymptomatic or may cause pain on urinating.
  • laryngeal involvement causes hoarseness.

Diagnosis

Once suspected, the diagnosis of blastomycosis is confirmed by demonstration of the organism, usually in the sputum, by KOH prep, culture or DNA antibody test. Organisms can also be found in skin ulcers along the margins.

Treatment

Amphotericin B is the treatment of choice, is highly effective, but is quite toxic. In milder cases, itraconazole can be used.

Prognosis

Mortality rate in treated cases

  • 0-2% in treated cases among immunocompetent patients
  • 29% in immunocompromised patients
  • 40% in the subgroup of patients with AIDS
  • 68% in patients presenting as acute respiratory distress syndrome (ARDS)

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South American blastomycosis
From Gale Encyclopedia of Medicine, 4/6/01 by Carol A. Turkington

Definition

South American blastomycosis is a potentially fatal, chronic fungus infection that occurs more often in men. The infection may affect different parts of the body, including the lungs or the skin, and may cause ulcers of the mouth, voicebox and nose.

Description

South American blastomycosis occurs primarily in Brazil, although cases crop up in Mexico, Central America, or other parts of South America. It affects men between ages 20 and 50 about 10 times more often than women.

The disease is far more serious than its North American variant (North American blastomycosis), which is endemic to the eastern United States, southern Canada, and the midwest.

South American blastomycosis is known medically as paracoccidioidal granuloma, or paracoccidioidomycosis. The infection has a very long incubation period (at least five years).

Causes & symptoms

South American blastomycosis is caused by the yeast-like fungus Paracoccidioides brasiliensis that is acquired by breathing in the spores of the fungus, which is commonly found in old wood and soil. It may appear very similar to tuberculosis; in fact, both diseases may infect a patient at the same time.

Symptoms include ulcers in the mouth, larynx and nose, in addition to large, draining lymph nodes, cough, chest pain, swollen lymph glands, weight loss, and lesions on the skin, genitals and intestines. There may also be lesions in the liver, spleen, intestines and adrenal glands.

Diagnosis

A physician can diagnose the condition by microscopic examination of a smear prepared from a lesion or sputum (spit). Biopsy specimens may also reveal the infection. While blood tests are helpful, they can't determine the difference between past and active infection.

Treatment

The primary goal of treatment is to control the infection. The best treatment has been amphotericin B. Sulfonamide drugs have been used and can stop the progress of the infection, but they don't kill the fungus.

Scientists are studying new treatments for the fungal infection, including ketoconazole, fluconazole and itraconazole, which appear to be equally effective as amphotericin B, according to research.

Prognosis

The disease is chronic and often fatal. Because blastomycosis may be recurrent, patients should continue follow-up care for several years.

Prevention

There is no way to prevent the disease.

Key Terms

Amphotericin B
A drug used to treat fungal infections.
Sulfonamide drugs
A group of antibacterial drugs used to treat infections of the lungs and skin, among other things.

Further Reading

For Your Information

    Periodicals

  • Cadavid, D., et al. "Factors associated with paracoccidioides Brasiliensis infection among permanent residents of three endemic areas in Colombia." Epidemiological Infections 111/1 (Aug. 1993):121- 133.
  • Diaz, M., et al. "A Pan-American 5-year study of fluconazole therapy for deep mycoses in the immunocompetent host." Clinical Infectious Diseases 14 (sup. 1) (March 1992):S68-76.

    Organizations

  • National Organization for Rare Disorders (NORD). PO Box 8923, New Fairfield , CT 06812. (203) 746-6518.
  • National Institute of Allergy and Infectious Diseases (NIAID). 9000 Rockville Pike, Bldg. 31, Rm 7A32, Bethesda, MD 20892. (301) 496- 5717.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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