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PubMed1976

Pulmonary manifestations of blastomycosis. Radiological support of a new concept.

The pulmonary manifestations of blastomycosis were observed in 51 patients and correlated with their location in the lungs and the clinical appearance of the patient. Blastomycosis is primarily an airbone infection that occurs in both acute and chronic forms and follows a specific pathway within the lungs. It must be strongly considered in the differential diagnosis of pulmonary lesions in geographical areas endemic to the disease.

Blastomycosis↗
PubMed1984

Miliary pulmonary blastomycosis.

Five patients with proved blastomycosis had a diffuse miliary nodular pattern seen on chest radiographs. These cases are presented to emphasize that blastomycosis may be the cause of a miliary pattern in an endemic area. Documentation requires recovery of the organism from body fluids or tissue since skin and serologic testing are unreliable indicators of active disease. With prompt diagnosis and appropriate treatment, the patient may recover from this form of endogenous disseminated reinfection that otherwise may be fatal, particularly in the immunocompromised host.

Adult↗
PubMed1992

Blastomycosis of the lung: CT features.

The authors reviewed the computed tomographic (CT) scans in 16 patients with pulmonary blastomycosis to describe the abnormalities seen at CT. The CT features were as follows: mass lesions (n = 14), consolidation (n = 9), air bronchograms (n = 14), intermediate-sized nodules (n = 12), satellite lesions (n = 11), pleural thickening (n = 4), small effusions (n = 2), and cavitation (n = 2). One patient had noncalcified hilar lymphadenopathy. Eight patients had acute disease, six had chronic disease, and two had acute exacerbation of a chronic illness. Fifteen patients had cough, fever, and/or dyspnea. Two patients underwent surgical resection for the presumptive diagnosis of bronchogenic carcinoma. In general, there was no correlation between the radiologic abnormalities and the clinical presentation. Consolidation occurred more frequently in acute disease. CT may be useful to help define the radiologic findings and distribution of disease. Familiarity with the characteristic CT findings of pulmonary blastomycosis may encourage an expeditious diagnostic approach to identify the disease and, possibly, prevent unnecessary surgical resection.

Adult↗
PubMed1987

Evaluation of enzyme immunoassay as a rapid screening test for histoplasmosis and blastomycosis.

This study evaluates the usefulness of enzyme immunoassay (EIA) as a screening test for serum antibodies to Histoplasma capsulatum and Blastomycoses dermatitidis and compares the results using this assay with those using complement fixation (CF), immunodiffusion (ID), and radioimmunoassay (RIA), in 12 patients with active histoplasmosis, 12 with active blastomycosis, 28 with other acute or chronic lung diseases and 25 healthy blood donors from an endemic area; EIA was as sensitive as RIA and more sensitive than CF and ID in the 24 patients with active fungal infections. The specificity of EIA was equal to that of the other serologic tests. We conclude that EIA is a useful screening test for serum antibodies to H. capsulatum and B. dermatitidis that avoids some of the problems associated with other sensitive assays such as RIA. A negative EIA result is evidence against invasive histoplasmosis or blastomycosis and suggests an alternative diagnosis.

Antigens, Fungal↗
PubMed1990

Significance of false-positive serologic tests for histoplasmosis and blastomycosis in an endemic area.

False-positive serologic tests for histoplasmosis (H) and blastomycosis (B) are common in populations from endemic areas. In order to determine the significance of false-positive test results, we reviewed the final diagnoses of all patients whose sera were submitted to our laboratory for radioimmunoassay (RIA) and immunodiffusion (ID) during a 3-yr period. Of the 263 patients whose sera were examined, 29 (11%) had H or B; 41 (17.5%) of the remaining 234 patients had false-positive test results. Of these 41 patients, 31 were positive for H alone, and 10 had antibodies to both H and B. All three patients with false-positive ID tests for histoplasmosis also had positive titers (greater than or equal to 1:16) on RIA. No patient had a false-positive ID result for blastomycosis. The percentage of patients in each of five major diagnostic categories with and without false-positive serologic tests was similar (p greater than 0.05). The majority of patients had pulmonary infections, almost half of which were granulomatous infections other than H or B; this reflects the clinical indications for requesting fungal serologic tests. A positive fungal serology is not useful in suggesting the presence of a pulmonary disease other than H or B in patients from an endemic area suspected of having a pulmonary mycosis.

Blastomycosis↗
PubMed1977

An urban epidemic of North American blastomycosis.

Five culturally proved cases of blastomycosis occurred in a 9-month period during 1974 and 1975 in a western suburb of Chicago. All patients lived within a 1-mile radius of the center of Westmont, Ill. (population, 12,000). Three of these patients lived in adjacent buildings in the same apartment complex. None of the patients had significant outdoor exposure. Dust from a nearby construction site was postulated as a possible common source, although soil cultures from the area were negative. This is the third chronologic epidemic of the blastomycosis; a fourth one has been reported. It is the only outbreak to occur in a major metropolitan area.

Adult↗
PubMed1979

Self-limited blastomycosis: a report of thirteen cases.

Blastomycosis is not generally recognized to be a self-limited pulmonary infection. We report 13 patients with blastomycosis who followed a self-limited course. Presenting complaints were usually those of an acute pulmonary infection with fever, productive cough, and pleurtiic chest pain. The duration of symtpoms before diagnosis was usuallms were variable and not diagnostic. The blastomycin skin test and complement-fixing serologies to blastomycin were generally not helpful. In all patients the diagnosis was made by either cultural or visual identification of the organism from sputum, bronchial washings, or pleural fluid. All patients were improving both clinically and by chest roentgenograms by the time the diagnosis was reached, and thus therapy was withheld. Follow-up of these 13 patients ranged from 5 months to 8 yr (mean, 43 months), and in no instance has there been any evidence of reactivation of the illness.

Adolescent↗
PubMed1981

Serologic response in blastomycosis: diagnostic value of double immunodiffusion assay.

Double immunodiffusion (DID) is a useful, inexpensive antibody screening test that is more specific than complement fixation for blastomycosis. Seven of 10 patients with proved blastomycosis had positive results on DID assays for antibody to the A antigen of Blastomyces dermatitidis. Sputum cytologic examination and skin or other tissue biopsies may be diagnostic if the organism is demonstrated. Culture remains the sina qua non of diagnosis, and a negative DID test result for A precipitin does not rule out this infection. Follow-up serologic studies of patients in remission and in relapse should be undertaken to determine the evolution of the immune response to the A antigen.

Adult↗
PubMed1983

Failure of ketoconazole in two patients with blastomycosis.

Two patients with severe pulmonary blastomycosis were treated with ketoconazole. One patient developed disseminated disease while receiving this drug. After responding to incomplete treatment with amphotericin B, this patient relapsed while continuing ketoconazole therapy. The second patient failed to respond to ketoconazole and died shortly after treatment with amphotericin B was instituted. We conclude that it is dangerous to use ketoconazole as initial treatment in patients with severe forms of blastomycosis. Death, relapse, and prolonged morbidity may be the result. In such cases, amphotericin B is still the drug of first choice despite its toxicity, inconvenience, and expense of administration.

Adolescent↗
PubMed1984

Disseminated inoculation blastomycosis in a renal transplant recipient.

We report a case of inoculation blastomycosis with dissemination to the lungs. The patient, a renal allograft recipient, was inoculated accidentally at the veterinarian's office where she worked. A nodular lesion appeared at the inoculation site, accompanied by lymphadenopathy and fever. Pulmonary infiltrates developed. Blastomyces dermatitidis was identified by both biopsy and culture from both inoculation site and lungs. Although not previously reported, inoculation blastomycosis can disseminate in an immunocompromised patient.

Accidents, Occupational↗
PubMedDate not supplied

Blastomycosis of the larynx.

Blastomycosis is an uncommon fungal disease which may mimic carcinoma of the larynx. Physical examination may show a granular appearance early in the disease with progression to laryngeal fibrosis. Histologic examination usually shows pseudoepitheliomatous hyperplasia, microabscesses, and giant cells. The broad-based budding yeast organisms may be easily overlooked unless special stains are used. Two cases of laryngeal blastomycosis which were originally treated as carcinoma are reported.

Aged↗
PubMed2006

Systemic blastomycosis in a horse.

Progressive multisystemic disease caused by Blastomyces dermatitidis was diagnosed in a 17-year-old Quarter horse broodmare. The mare had been treated unsuccessfully with antibiotics for mastitis 3 months postpartum. The disease progressed to exudative cutaneous lesions affecting the ventrum, pectoral region, and limbs accompanied by weight loss across several months. Yeast bodies were observed in swabs of the cutaneous exudate, suggesting a clinical diagnosis of blastomycosis. Following referral, pleural effusion, cavitated lung lesions, and hyperproteinemia were identified, and the mare was euthanized because of poor prognosis. Necropsy revealed extensive pyogranulomas in the mammary gland, skin, subcutaneous tissues, and lungs, accompanied by thrombi in major blood vessels of the lungs and hind limbs. Histologically, pyogranulomatous inflammation was evident in many tissues, and fungal organisms were seen in sections of mammary gland, skin, subcutis, pericardium, and lung. Blastomyces dermatitidis was cultured from mammary tissue, lungs, lymph node, and an inguinal abscess. Although blastomycosis is endemic in the area of origin of the mare in northwestern Wisconsin, the disease is extremely rare in horses and hence easily misdiagnosed. Unique features of this case included the extent of mammary gland involvement and the presence of thrombi in multiple sites.

Animals↗
PubMed2005

Paradise -- not without its plagues: overwhelming Blastomycosis pneumonia after visit to lakeside cottages in Northeastern Ontario.

BACKGROUND: Visiting lakes and cottages is a common leisure activity during summer among most Canadians and paradise for some. Various leisure activities are involved during these visits, including cleaning and 'airing' the cottage after long-winters, activities at the lakes and dock building etc, exposing the Canadians to moist soil and decaying woods -- a source of white or tan mould -- Blastomyces dermatitidis that may cause a flu-like illness to severe pneumonia that often remains a diagnostic challenge and results in delay in diagnosis and appropriate treatment thereby increasing associated morbidity and mortality. CASE PRESENTATIONS: Five cases of overwhelming acute blastomycosis pneumonia are presented. Four of the five patients presented within few weeks of their visit to the cottages and surrounding lakes and all were initially treated as "community acquired pneumonia" that resulted in delay in diagnosis and poor outcome in the first patient. The first case, however, taught an important lesson that led to high-index of suspicion in the others with early diagnosis and improved outcomes. Interestingly, all patients were obese and had a shorter incubation period and severe clinical course. The possible mechanism for early and severe disease in association with obesity is speculated and literature is reviewed. CONCLUSION: High-index of suspicion is important in the early diagnosis and appropriate management acute blastomycosis pneumonia to improve associated morbidity and mortality.

Acute Disease↗
PubMed1976

Clinical and roentgenographic manifestations of acute and chronic blastomycosis.

Roentgenograms and hospital records of 50 patients with blastomycosis proven by cultures were analyzed to determine possible differences between the acute and chronic forms of the illness. Six patients had acute blastomycosis with symptoms occurring three weeks or less prior to hospitalization. The remaining 44 patients had chronic illnesses with symptoms occurring up to six years (mean duration, ten months before hospitalization). The acute illness was characterized by toxic symptoms, chest pain without visible effusions, pneumonic-type consolidations on the chest films, and a relatively benign course. The chronic illness had less severe toxicity, but a high incidence of dissemination, with pleural reactions, hepatosplenomegaly, and cutaneous and osseous involvement. Sputum cultures were positive for Blastomyces dermatitidis in 36 of 46 patients; however, several specimens were frequently required for demonstration of the organism on wet preparations. Pleural fluid and material from skin lesions were also likely sources of the fungus. Skin tests and serologic studies were not helpful in most cases of either the acute or chronic form of the disease.

Acute Disease↗
PubMed1977

Exfoliative cytology in the rapid diagnosis of pulmonary blastomycosis.

Four patients with pulmonary blastomycosis are reported. Their bronchial washings, submitted for cytologic evaluation and stained by the standard Papanicolau technique, yielded the diagnosis, subsequently confirmed by cultural identification of the fungus. In three additional cases, retrospective evaluation of cytologic material also revealed the organism, even though the diagnostic significance was not appreciated originally. Since cytologic techniques are simple, readily available, and rapid, they can be helpful in differentiating pulmonary neoplasms from pulmonary blastomycosis, thus reducing the need for diagnostic thoracotomies.

Adolescent↗
PubMed1984

The spectrum and significance of pleural disease in blastomycosis.

To determine the incidence and significance of pleural disease in blastomycosis, we reviewed the chest roentgenograms and medical records of 26 consecutive patients with biopsy- or culture-proved Blastomyces dermatitidis infection. Twenty-three of the 26 (88 percent) had radiographic evidence of blastomycotic pleural disease. Pleural reaction that regressed on therapy was mild (less than 1.0 cm thickening on EPA chest film) in 12. More extensive pleural thickening (1.5 to 3.0 cm) was observed in five, while four had effusions, and two had pneumothoraces. The 15 patients with mild or no visible pleural thickening were considered to have minor pleural involvement, while the 11 patients with greater than 1.5 cm pleural reaction, effusions, or pneumothoraces were considered to have major pleural disease. The ages, incidence of serious underlying disorders, and extra-thoracic dissemination were similar in both groups. Chest pain was more frequent in those with major pleural involvement (8/11 vs 4/15, p = 0.02), and their white blood cell count (14,300 +/- 1,200 c/mm3) was significantly higher than that of those with minor pleural involvement (10,600 +/- 1400, p less than 0.05). All of the patients with minor pleural disease responded to amphotericin therapy, but four of 11 (36 percent) with major pleural disease had an unfavorable outcome (relapse = two, death = two) (p = 0.02). In these patients with blastomycosis, pleural involvement was extremely common. Major pleural disease was associated with an adverse prognosis and may be an indication for prolonged therapy.

Adult↗