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PubMed1984

A case of blastomycosis from Zaria, Nigeria.

A case of blastomycosis from Zaria, Nigeria is reported. The clinical features were indistinguishable from those of tuberculosis which is very common in this environment. Lack of response to anti-tuberculosis therapy within eight weeks prompted the search for other organisms which resulted in the isolation of Blastomyces dermatitidis. Compatible histological evidence was obtained. Subsequent favourable response to amphotericin B was evident. Infection with this organism should be included in the differential diagnosis of pulmonary and pleural lesions simulating tuberculosis in West Africa.

Adult↗
PubMed2005

Coccidioidomycosis and blastomycosis: advances in molecular diagnosis.

Clinical isolates of Coccidioides spp. and Blastomyces dermatitidis can be identified by chemiluminescent DNA probes and PCR assays targeting multicopy genes. In fixed tissue samples, cells of the two fungi are specified by in situ hybridization and PCR assays targeting 18S rDNA but sequencing of the products is mandatory. Nested PCR assays targeting genes encoding species- or genus-specific proteins like proline rich antigen of Coccidioides spp. and B. dermatitidis adhesin facilitate amplification of specific DNA from fixed tissue samples. The value of DNA amplification from native specimens of suspected cases of coccidioidomycosis or blastomycosis still needs to be determined.

Animals↗
PubMed2006

Endemic mycoses: blastomycosis, histoplasmosis, and sporotrichosis.

The endemic mycoses are diverse group of fungi that share several characteristics. They are able to cause disease in healthy hosts, they each occupy a specific ecologic niche in the environment, and they exhibit temperature dimorphism, existing as molds in the environment at temperature of 25 degrees C to 30 degrees C, and as yeasts, or spherules in the case of coccidioidomycosis, at body temperatures. This article discusses histoplasmosis and blastomycosis. Sporotrichosis, which differs in that it is usually a localized lymphocutaneous infection, is included because it shares the characteristics of endemic mycoses.

Antifungal Agents↗
PubMed1985

Blastomycosis of the esophagus presenting with gastrointestinal bleeding.

A patient with abdominal discomfort and hematemesis was found to have lower esophageal inflammation on endoscopy. A biopsy specimen from this area showed yeast forms of Blastomyces dermatitidis with a polymorphonuclear infiltrate and granuloma formation. Extensive evaluation showed no other bleeding site. Sputum samples obtained earlier also showed B. dermatitidis. Treatment with amphotericin B led to resolution of bleeding and eradication of the fungus on repeat biopsy and sputum samples. An esophageal stricture subsequently developed and required dilation. Seven previously reported cases of esophageal blastomycosis are reviewed.

Aged↗
PubMed1975

Blastomycosis of the genitourinary tract.

In a retrospective study of 51 cases of systemic North American blastomycosis 11 patients were found to have genitourinary tract involvement, the prostate and epididymis being most commonly affected. Diagnosis was made by culture of the fungus from urine, abscess or prostate secretions, morphologic identification of the characteristic organism in urine or secretions, or histologic examination of tissue specimens. Treatment with amphotericin B reduced the mortality rate of 90 per cent to as low as 10 per cent. Long-term followup is necessary because of a relapse rate of 10 to 15 per cent.

Adult↗
PubMed1996

Blastomycosis.

Blastomycosis is a relatively uncommon disease, even in its endemic region. The clinical course and symptoms are highly variable; patients may be asymptomatic or present with severe, fulminant disease. Antifungal agents are effective against pulmonary and disseminated disease, but relapses and reactivation can occur. The radiographic findings are nonspecific, and patients are often assumed to have bacterial pneumonia, malignancy, tuberculosis, or sarcoidosis before the correct diagnosis is made.

Adult↗
PubMedDate not supplied

Blastomycosis-induced respiratory failure: the successful application of continuous positive airway pressure.

A patient diagnosed with pulmonary blastomycosis was seen initially by her primary care physician for severe pain in her right elbow and was treated with steroid therapy and analgesics. She also had been treated for chronic cough and congestion for approximately 2 months before admission. She showed no improvement at home. She was hospitalized for right epicondylitis, and progressively worsening restrictive pulmonary symptoms developed, including hypoxemia and dyspnea. She was transferred to the intensive care unit and treated with mask continuous positive airway pressure (CPAP) and intravenous amphotericin B. Despite worsening hypoxemia, successful management of oxygenation was achieved with CPAP, averting the need for intubation and mechanical ventilation. This case demonstrates the usefulness of CPAP in infectious disorders that create restrictive lung impairment.

Blastomycosis↗
PubMed1986

Intracerebellar blastomycosis abscess in an African man.

The case of a solitary cerebellar abscess in a 36-year-old Rwandese male is described. First it was considered to be tuberculosis, but at microscopal examination of the lesion after neurosurgical excision the true germ was found: Blastomyces dermatitidis. This solitary intracerebellar blastomycosis abscess is only the fifth case reported worldwide and the first in African medical annals.

Adult↗
PubMed1999

Murine models of blastomycosis, coccidioidomycosis, and histoplasmosis.

Animal models have contributed much to the knowledge of fungal infections and their corresponding therapeutic treatments. This is true for animal models of the primary fungal pathogens, Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum. This review gives a brief background of human diseases associated with these organisms and describes the development, details, and utility of murine models of blastomycosis, as well as coccidioidomycosis and histoplasmosis.

Animals↗
PubMed2002

Cluster of pulmonary blastomycosis in a rural community: evidence for multiple high-risk environmental foci following a sustained period of diminished precipitation.

Much of our understanding of the epidemiologic features of infection with Blastomyces dermatitidis has come from cluster and outbreak investigations which have established the association of human disease with recreational pursuits and the presence of infectious microfoci in areas of moist soil with high organic content. This report describes the clustering of eight cases of pulmonary blastomycosis without an apparent common source exposure which occurred during a 90 day period in a 96 square mile area (population 4,450) within Oconto County, Wisconsin. We conclude that multiple high-risk environmental foci may have existed following a sustained five-year period of diminished precipitation in the cluster area. A case-control study which included family and community controls concluded that multiple earth-disturbing activities engaged in by case-patients was statistically associated with illness. Lymphocyte-proliferation assays of whole blood samples detected previously unrecognized infection with B. dermatititidis among five of 32 family controls.

Adolescent↗
PubMed2005

Epidemiology, diagnosis, and treatment of blastomycosis in dogs and cats.

Blastomycosis is one of the most common systemic fungal diseases in dogs in North America, but it is rarely diagnosed in cats. The typical route of infection is inhalation of aerosolized conidia of Blastomyces dermatitidis. From the respiratory tract, the developing yeast form may disseminate throughout the body and affect multiple organ systems, most commonly the lymphatic, skeletal and central nervous systems, eyes and skin. Disseminated disease often is associated with nonspecific signs of illness including lethargy, inappetence and fever, as well as signs referable to specific organ systems like chronic cough and dyspnea, peripheral lymphadenopathy, endophthalmitis, and central nervous signs. Diagnosis is typically made by detection of Blastomyces dermatitidis yeast in affected tissues by fine-needle aspiration cytology or histopathology. The treatment of choice is itraconazole. Prognosis is fair in dogs without central nervous disease and guarded in cats.

Animals↗
PubMed1993

Overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome.

BACKGROUND AND METHODS: Few cases of overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome have been reported. We describe 10 patients with this condition who were treated at one center in Wisconsin. RESULTS: All 10 patients presented with fever, cough, and dyspnea; radiographic evidence of diffuse pulmonary infiltrates; and marked impairment of oxygenation. The mean alveolar-arterial oxygen gradient was 616 mm Hg. Six of the patients had no underlying disease associated with altered immunity, and two had no recent exposure to environmental reservoirs of Blastomyces dermatitidis. In all 10 patients, large numbers of broad-based budding yeasts were seen on microscopical examination of tracheal secretions. All patients were treated with intravenous amphotericin B (0.7 to 1.0 mg per kilogram per day). Of the five survivors, four received full doses of amphotericin B in the first 24 hours, and four required mechanical ventilatory support for 7 to 151 days. Long-term follow-up of three survivors showed good recovery of pulmonary function. CONCLUSIONS: Overwhelming infection with B. dermatitidis can cause diffuse pneumonitis and the adult respiratory distress syndrome, even in immunocompetent hosts. With prompt diagnosis by microscopical examination of tracheal secretions, intensive therapy with amphotericin B, and ventilatory support, good recovery of pulmonary function is possible.

Adult↗
PubMed2005

Geographic information system analysis of blastomycosis in northern Wisconsin, USA: waterways and soil.

Geographic information systems (GIS) are powerful tools for investigating the ecogeography of environmentally acquired infections. GIS technology was used to geocode and map cases of blastomycosis, by household, of human and dog residents of Vilas County, Wisconsin, USA. Human case households (n = 136) were from a comprehensive street address registry 1979--2001; human controls were 200 random-number selected households from 2001 county tax records. Dog cases (n = 116) were from a consecutive street address registry from a private veterinarian practice, Eagle River; dog controls were 200 random-number selected addresses from the 2001 total practice registry. Where geocoding was not available from existing maps, home sites were visited and geocoded using a handheld global positioning system (n = 61). Waterway characteristics were obtained from the Wisconsin Department of Natural Resources GNIS database, soil type data from the USDA. Data were analysed with chi-square and Mann-Whitney tests; cluster analysis with CrimeStat II software. A disproportionate number of human and dog cases were associated with waterways of the western Eagle River area. Human and dog cases were more commonly near waterways < 500 m elevation (more nutrient rich) (P < or =0.001 for both) and were associated with sands (prone to drought) (P < or = 0.01 for both). When the nearest waterway was a lake, case addresses were more commonly near lakes with <7.6 m maximum depth (more lake mixing) (P <0.05, humans and dogs) but mean depth, type and size of lakes did not differ from controls. Further studies are needed to clarify the nature of these associations.

Animals↗
PubMedDate not supplied

Comparison of fluconazole and ketoconazole in experimental murine blastomycosis.

Fluconazole, a new oral triazole antifungal agent, was tested against Blastomyces dermatitidis in vitro and in a murine model (pulmonary challenge) and compared with ketoconazole, an oral imidazole known to be effective against this agent in mice and in humans. Although fluconazole appeared less active than ketoconazole in vitro, in experiments involving 3 weeks of treatment and 2 months of observation, fluconazole was greater than 10 times as potent (mg/kg) in vivo against blastomycosis (prolongation of life). In the model neither drug was curative at the doses and regimens used. A possible explanation for the efficacy of fluconazole in vivo is its favorable pharmacokinetic profile (i.e., prolonged serum concentrations that exceeded the MIC for the pathogen after oral administration). Dosages of 100 mg/(kg.d) were tolerated for 3 weeks without evident toxicity.

Animals↗
PubMed1993

Therapeutic efficacy of a liposomal formulation of amphotericin B (AmBisome) against murine blastomycosis.

The efficacy of a liposomal amphotericin B preparation (AmBisome) and a deoxycholate suspension (Fungizone) were compared in a pulmonary model of murine blastomycosis. Male, four-week-old CD-1 mice were infected intranasally with 19,400 or 27,450 cfu of viable Blastomyces dermatitidis yeasts and intravenous therapy begun 4 days later. Groups of ten mice were given various dosages of Fungizone or AmBisome or were untreated. All treatments were given 3 times per week for 2 weeks. Deaths were recorded over 49 days and the number of viable yeasts in the lungs of survivors quantitated by viable counting. Therapy with 1.0 mg/kg/dose of Fungizone or 1.0, 3.0, 5.0, 7.5 or 20.0 mg/kg/dose of AmBisome were equivalent and prolonged survival over controls and lower dosages of each drug. No acute or chronic toxicities were observed with any regimen. Quantitation of residual numbers of yeasts in the lung showed that 70-100% of mice given 7.5 mg/kg or greater of AmBisome were free of infection and were superior to other regimens. At equivalent 1.0 mg/kg dosages Fungizone was superior to AmBisome. Although AmBisome was three-fold less active than Fungizone on a dosage basis, higher curative doses could be given that were not toxic. These data indicate that AmBisome should be further tested in other models and in clinical trials.

Amphotericin B↗
PubMed2003

Sweet's syndrome-like blastomycosis.

Cutaneous North American blastomycosis is characterized clinically by verrucous nodules and histologically by pseudoepitheliomatous hyperplasia, intraepidermal neutrophilic microabscesses, and a dermal mixed inflammatory cell infiltrate containing giant cells. We describe a patient who presented clinically with erythematous nodules and plaques on the lower extremities characterized histologically by a diffuse neutrophilic infiltrate, with lack of epidermal hyperplasia. The lesions were clinically and histologically reminiscent of Sweets syndrome. On close microscopic inspection scattered histiocytes and multinucleated giant cells were present in the dermis, and fungal stains demonstrated budding yeast forms consistent with Blastomyces sp.

Aged↗
PubMedDate not supplied

Systemic blastomycosis in children.

Ten pediatric patients with systemic blastomycosis in Arkansas are reviewed. No particular age predisposition in childhood is apparent and there has been no change in incidence over the previous 40 years. Six of the 10 cases were male and 8 were black. Organ systems most commonly involved were pulmonary, skeletal and skin. With current therapy, usually amphotericin B as a single agent, the case fatality rate is less than 10%. Early recognition and institution of appropriate antifungal treatment remain the most important factors for survival and prevention of chronic pulmonary disease.

Adolescent↗