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PubMed1989

Blastomycosis in Africa. A review of known cases diagnosed between 1951 and 1987.

The known African cases of blastomycosis to 1987 are presented, including thirteen previously undescribed cases. This brings to 81 the total number of cases known to have occurred in Africa. The question of whether the disease in Africa is the same in all respects as that in North America is addressed; the age and sex distributions of patients are similar. Minor differences in the clinical features relate particularly to the type of skin lesion, the more frequent bone involvement and the less frequent central nervous system involvement in the African patient. Little is known about the epidemiology of blastomycosis in Africa; one noteworthy feature is the apparent absence of the disease in dogs. Isolates of Blastomyces dermatitidis from the two continents, although closely related, differ in some respects.

Africa↗

PubMed2006

Detection of IgG and IgM in sera from canines with blastomycosis using eight blastomyces dermatitidis yeast phase lysate antigens.

The objective of this study was to compare the efficacy of eight Blastomyces dermatitidis yeast phase lysate antigens (T-58: dog, Tennessee; T-27: polar bear, Tennessee; ERC-2: dog, Wisconsin; B5894: human, Minnesota; SOIL: soil, Canada; B5896: human, Minnesota; 48089: human, Zaire; 48938: bat, India) in the detection of the immunoglobulins IgG and IgM in serum specimens from canines with blastomycosis. An indirect enzyme-linked immunosorbent assay (ELISA, peroxidase system) was used to analyze sera collected during four different intervals post-infection. The yeast lysate antigen 48938 was a reactive antigen for the detection of both IgG (mean absorbance value range: 1.198-2.934) and IgM (mean absorbance value range: 0.505-0.845). For the same sera, antigen T-27 was also effective in the detection of IgG (mean absorbance value range: 0.904-3.356) and antigen 48089 was useful for the detection of IgM (mean absorbance value range: 0.377-0.554). The yeast lysate antigen B5894 proved to be a poor antigen for the detection of both IgG and IgM (mean absorbance value ranges: 0.310-0.744 for IgG, 0.025-0.069 for IgM). Inherent variations in yeast lysate antigens such as these may be utilized to develop improved immunoassay procedures for the specific detection of IgG or IgM in cases of blastomycosis.

Animals↗

PubMed1980

Lymphocyte function in relapsed pulmonary blastomycosis.

Lymphocyte function was studied in two patients with multiple relapses of pulmonary blastomycosis following antifungal therapy. Neither patient was anergic to routine delayed hypersensitivity skin testing with common antigens. Both had normal in vitro lymphocyte transformation responses to standard mitogens and common microbial antigens. The ability of lymphocytes from the two patients to respond to antigens of the infecting organism was evaluated using a yeast phase Blastomyces dermatitidis extract in tests of in vitro lymphocyte function. Both patients demonstrated positive responses to this extract in standard assays of two in vitro parameters of lymphocyte function, lymphocyte transformation, and lymphokine production. Therefore if an immunologic defect is responsible for the repeated relapses of treated pulmonary blastomycosis in these two patients, it apparently is not one of deficient lymphocyte responsiveness against the infecting organism, as has been found using similar techniques in patients with disseminated deep infections caused by other fungal organisms.

Antigens, Fungal↗

PubMed1993

Disseminated blastomycosis masquerading as tuberculosis.

Two patients were mistakenly treated for several months for tuberculosis. Both had lung and vertebral involvement and one patient had superficial skin lesions as well. Blastomycosis was eventually confirmed by fungal culture, but only after both patients had deteriorated markedly; one died soon after treatment with amphotericin B was started. In Africa, blastomycosis is a relatively rare condition which can mimic tuberculosis; it is one of several infections which should be borne in mind when dealing with apparently non-responsive tuberculosis.

Adult↗

PubMed1987

Development of a comparative dot ELISA for the detection of antibodies in blastomycosis.

We present a preliminary study utilizing an enzyme immunoassay for the detection of antibodies in blastomycosis using nitrocellulose membrane as the solid support. The comparative dot enzyme-linked immunosorbent assay (CDE) utilizing Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis antigens allows rapid screening of specimens and determination of a serum profile with respect to anti-Blastomyces antibodies. Sensitivity (76% or greater) and specificity (approximately 12% crossreactivity) determinations indicated that this visual assay may be an alternative antibody detection method for blastomycosis or other systemic fungal diseases.

Antibodies, Fungal↗

PubMed2006

IL-12 induction of resistance to pulmonary blastomycosis.

BACKGROUND: Why severity varies in blastomycosis outbreaks remains unresolved. In experimental pulmonary blastomycosis, susceptibility varied in mouse strains. In susceptible BALB/c the response is Th-2, in immunized, resistance is associated with Th-1. Can susceptibility be redirected by IL-12? Methods, results: BALB/c bronchoalveolar and peritoneal macrophages (PM) were shown deficient in IL-12 production in response to IFN-gamma+LPS. High dose IL-12 (1 microg, subcutaneously) treatment of BALB/c infected intranasally with Blastomyces resulted in enhanced survival (P<0.008). Since IL-12 was poorly tolerated, a new protocol for infected mice, IL-12 0.1 or 0.3 microg, every other day, resulted in minimal toxicity; almost all treated mice survived (P<0.002 vs. controls). When lungs of surviving mice were cultured, the 0.1 microg regimen resulted in fewer (P<0.02) cfu. For weeks after treatment, in vitro IFN-gamma treatment enabled PM Blastomyces killing. After infection spleen cells from IL-12 treated mice produced 4-fold more IFN-gamma and 3-fold less IL-10 in response to Blastomyces. IL-10 abrogated activation of macrophages by IFN-gamma for enhanced Blastomyces killing. CONCLUSIONS: A proper IL-12 treatment protocol induces resistance (survival and decreased growth in lungs), low toxicity, macrophage responsiveness to IFN-gamma for killing Blastomyces, up-regulation of IFN-gamma and down-regulation of IL-10 production.

Adjuvants, Immunologic↗

PubMed1980

Blastomycosis of the esophagus.

A patient had clinical, endoscopic, and roentgenographic signs of esophageal carcinoma, but biopsies and brushings were negative. At operation he was found to have blastomycosis localized to the esophagogastric region and adjacent lymph nodes. There was no evidence of pulmonary disease. He was treated successfully by partial esophagectomy and amphotericin. The literature on esophageal blastomycosis is reviewed.

Adult↗

PubMed1983

Blastomycosis presenting with prostatic involvement: report of 2 cases and review of the literature.

We report on 2 patients who presented with prostatic involvement as the first prominent clinical manifestation of systemic blastomycosis. The clinical symptoms of both patients began with dysuria and urinary retention. In 1 patient skin lesions developed 4 weeks later and the initial chest x-ray findings were positive. The other patient became aware of skin lesions concurrently with the urinary symptoms and had negative chest x-ray findings. Successful treatment consisted of amphotericin B in 1 case and ketoconazole in the other case. A review of the literature revealed 8 well documented cases of blastomycosis with the initial presenting symptom of prostatic involvement. A summary of the previously reported cases is presented and the importance of recognition of skin lesions in such patients is stressed.

Adult↗

PubMed1985

Survival in adult respiratory distress syndrome caused by blastomycosis infection.

A 32-year-old man with diabetes had rapid development of acute respiratory failure and severe hypoxemia. Radiologic and hemodynamic evaluation confirmed the clinical diagnosis of adult respiratory distress syndrome, and open-lung biopsy disclosed blastomycosis as the etiologic agent. The survival of this patient, after amphotericin therapy, to our knowledge is the first reported recovery from substantiated adult respiratory distress syndrome secondary to blastomycosis.

Acute Disease↗

PubMed1991

Roentgenologic features of pulmonary blastomycosis.

In 35 cases of pulmonary blastomycosis, the roentgenologic features were as follows: consolidation 26%, mass 31%, intermediate-sized nodules 6%, miliary pattern 11%, solitary cavity 9%, fibrotic and cavitary changes 6%, interstitial pattern 6%, diffuse alveolar involvement 3%, and mixed alveolar and interstitial infiltrate 3%. All symptomatic cases of consolidation were acute (symptoms for less than 1 month), and most were in young patients (mean age, 34 years). Consolidation constituted 58% of the acute cases in this series. Two of the nine cases of consolidation were asymptomatic epidemic cases detected by screening. A pulmonary mass was the most common initial manifestation in this series; it tended to occur in patients with chronic symptoms (more than 1 month). The mass was considered suggestive enough of bronchogenic carcinoma to necessitate resection in 55% of cases. The military form of pulmonary blastomycosis occurred in older patients with disseminated disease. Fibrotic and cavitary disease was chronic in nature. The presence of intermediate-sized nodules elsewhere in the lung proved to be a helpful diagnostic finding in several patients with consolidation, mass, or cavitary disease. Hilar adenopathy, postinfectious calcification, chest wall invasion, and pleural effusion occurred infrequently or not at all in this series.

Adolescent↗

PubMed1997

Blastomycosis of the epididymis and prostate.

We report a case of blastomycosis presenting as epididymitis and prostatitis. The diagnosis was suggested by pathologic findings in the prostate and epididymis and was further supported by serology. The diagnosis was confirmed by culture and special staining. Long-term cure was accomplished after a 12-month course of oral ketoconazole (400 mg/day). Therapy was monitored by culture and serology. Blastomycosis is an unusual but significant pathogen which occasionally presents with genitourinary tract involvement. Effective diagnostic and oral treatment regimens are now available but are dependent on a high degree of suspicion in cases of chronic prostatitis or epididymitis.

Adult↗

PubMed1982

Primary inoculation blastomycosis in a veterinarian.

A veterinarian cut his finger while performing an autopsy on a dog subsequently confirmed to have died of blastomycosis. A typical chancriform complex developed at the site of inoculation. Culture of the lesion grew Blastomyces dermatitidis. Healing of the lesion occurred after 7 months and a course of potassium iodide. This is the first reported case of a canine necropsy accident leading to primary inoculation blastomycosis.

Adult↗

PubMed1990

Successful treatment of systemic blastomycosis with high-dose ketoconazole in a renal transplant recipient.

A case of disseminated blastomycosis in a male renal transplant recipient is presented. Discontinuation of immunosuppressive therapy and treatment with high-dose ketoconazole was successful in treating the patient's cutaneous and pulmonary disease initially. Ketoconazole was discontinued after 12 months of chronic therapy, but 2 weeks after discontinuation, blastomycosis recurred. High-dose ketoconazole was again effective; the patient remains asymptomatic presently on chronic suppressive therapy with ketoconazole.

Aged↗

PubMed2003

Blastomycosis.

Blastomycosis is an endemic mycoses in the central United States caused by a dimorphic fungus, Blastomyces dermatitidis, that exists in nature in mycelial phase and converts to yeast phase at body temperature. The organism may produce epidemics of infection following a point source of infection or sporadic endemic infection. Blastomycosis can be a subclinical illness with subsequent protection against progressive infection afforded by cellular immune mechanisms, but it may present with progressive disease with either pulmonary or extrapulmonary disease or both. Itraconazole has been shown to be the drug of choice for both infections, except in cases of life-threatening infection when amphotericin B should be used.

Blastomyces↗

PubMed2003

Blastomyces dermatitidis lysate antigens: antibody detection in serial serum specimens from dogs with blastomycosis.

Yeast phase lysate antigens prepared from different isolates of Blastomyces dermatitidis (T-58, dog-Tennessee; T-27, polar bear-Tennessee; ERC-2, dog-Wisconsin; ER-3, woodpile-Wisconsin) were compared with respect to the detection of antibodies (indirect enzyme-linked immunosorbent assay-ELISA, peroxidase system) in 126 serial serum specimens (pre-treatment, 30 and 60 days post-treatment with itraconazole) from 42 dogs with diagnosed blastomycosis. Mean absorbance values observed with the four lysate antigens at the three treatment intervals ranged from the most reactive to the least reactive as follows: T-58 (0.270, 0.210, 0.136); T-27 (0.209, 0.156, 0.096); ER-3 (0.189, 0.144, 0.089) and ERC-2 (0.158, 0.129, 0.080). Even though variations in reactivity were evidenced, the lysates prepared from isolates from various geographical regions and sources were all efficacious as antigens for the immunodiagnosis of canine blastomycosis.

Animals↗

PubMed2000

Histopathological evidence of North American blastomycosis in Italy: report of two cases.

No clinical reports of blastomycosis in Italy have been published until now. We here report two cases of histologically diagnosed, unexpected cutaneous involvement in patients, aged 78 and 52 years, living in North Italy and never having been abroad. The histological differential diagnosis between blastomycosis and other fungal pathogens is discussed. Even in the absence of culture the present cases can confidently be considered as genuine examples of Blastomyces dermatitidis infection in Italy.

Adult↗

PubMed2002

Comparison of seven Blastomyces dermatitidis antigens for the detection of antibodies in humans with occupationally acquired blastomycosis.

Yeast phase lysate antigens, prepared from seven isolates of Blastomyces dermatitidis (dogs, T-58, M-98; human, Le; soil, S; sea lion, SL; polar bear, PB; cat, C) were assayed by enzyme-linked immunosorbent assay (ELISA) to detect antibodies in human sera. The sera were from individuals potentially exposed to B. dermatitidis while working on a prairie dog relocation project in Colorado. All antigens exhibited greatest reactivity with three specimens in two separate assays. Absorbance values ranged from 0.370 (M-98) to 0.427 (LE) (Trial 1) and from 0.579 (M-98) to 0.714 (PB) (Trial 2) with serum 2; from 0.368 (C) to 0.453 (LE) (Trial 1) and from 0.565 (SL) to 0.694 (S) (Trial 2) with serum 3 and from 0.392 (M-98) to 0.506 (LE) (Trial 1) and from 0.557 (SL) to 0.758 (T-58) (Trial 2) with serum 6. The greatest reactivity was observed with sera from two persons (2 and 3 from the same individual and serum 6) who became ill with symptoms of pulmonary disease and sought medical care. Both patients were subsequently diagnosed with blastomycosis by microscopic and culture methods. The study indicated that all of the lysate antigens, regardless of source, could be used to reliably diagnose blastomycosis.

Animals↗

PubMedDate not supplied

Primary cutaneous north american blastomycosis in an immunosuppressed child.

Primary cutaneous blastomycosis and primary cutaneous sphaeropsidale infections are rare in children. We present a 6-year-old immunosuppressed girl who had a solitary ulceration on her left lower leg which showed histopathologic findings of blastomycosis. She responded readily to oral itraconazole.

Biopsy, Needle↗