BLASTOMYCOSIS

NARENDRA SHANMUGAM
GROUP 22

Synonyms - Chicago Disease, Gilchrist's

disease, North American Blastomycosis
Blastomycosis is a disease caused by the
fungus Blastomyces dermatitidis. The fungus
lives in moist soil and in association with
decomposing organic matter such as wood
and leaves.

The infection is acquired via inhalation

of the conidia, which transform into the
yeast form once in the lungs. After 30
to 45 days an acute pulmonary disease
may occur.

However, at least 50% of primary

infections are asymptomatic.

Risk Factors
Underlying

medical conditions such as diabetes may be

at increased risk for the infection.
People

who live in endemic areas and engage in

activities that expose them to wooded areas may be at a
higher risk for getting blastomycosis.
This

may include farmers, forestry workers, hunters,

and campers.

Forms of the disease

a) asymptomatic
b) acute pulmonary
c) chronic pulmonary
d) skin diseases
e) subcutaneous nodules
f) bone & joint affection
g) genitourinary tract infection

Symptoms
A self-limited

flulike illness with fever, chills, myalgia,

headache, and a nonproductive cough
An acute illness resembling bacterial pneumonia, with high
fever, chills, a productive cough, and pleuritic chest pain;
mucopurulent or purulent sputum
Chronic illness, with low-grade fever, a productive cough,
fatigue, night sweats, and weight loss
Rapidly progressive, and severe disease, eg, multilobar
pneumonia or ARDS, with fever, shortness of breath, tachypnea,
hypoxemia, and finally hemodynamic collapse

Skin symptoms occur in about 80% of people

whose blastomycosis infection spreads beyond
their lung.
Papules, pustules, or nodules are most
frequently found on exposed body areas.
They may look like warts or ulcers.
They are usually painless.
They may vary from gray to violet in color.

The pustules may:

Form ulcers
Bleed easily
Occur in the nose or mouth
Over time, these skin lesions can lead to
scarring and loss of skin color (pigment).

Blastomycosis gross: Multiple granulomas are

scattered throughout the parenchyma

Extrapulmonary manifestations are present in 25-40% of cases and

may present with:
Cutaneous

lesions Usually either verrucous or ulcerative and

may be asymptomatic
Osteoarticular lesions Cause bone or joint pain; soft-tissue
swelling possible; possible involvement of any bone may be
involved, but the vertebrae and pelvis are common sites
Genitourinary manifestations including prostatitis and
epididymitis May be asymptomatic or may cause pain on
urinating
Central nervous system involvement Intracranial or epidural
abscesses and meningitis

A verrucous cutaneous lesion due

to blastomycosis

A cutaneous ulcer without exudate on the nose

An exudative, ulcerative cutaneous lesion on medial aspect of

the right elbow of a man with blastomycosis

Diagnosis
Direct

examination
Clinical material, such as fluids, prostate fluid, sputa, or tissue, is
examined in 10% KOH - broad based budding organisms
Fungal

cultures and smear

X-ray
Tissue
Urine

biopsy

antigen test

Differential Diagnosis
Halogenoderma
Chromoblastomycosis
Squamous

Cell Carcinoma
Histoplasmosis
Tuberculosis
Influenza
Actinomycosis
Aspergillosis

Treatment
For

mild to moderate disease, itraconazole 200 mg po

tid for 3 days, followed by 200 mg po once/day or bid
for 6 to 12 mo is used.
Fluconazole

appears less effective, but 400 to 800 mg

po once/day may be tried in itraconazole-intolerant
patients with mild disease. Excellent CNS penetration
and is useful where there is CNS involvement after
initial treatment with Amphotericin B.

Ketoconazole
For

severe, life-threatening infections, IV

amphotericin B is usually effective; therapy is
changed to itraconazole once patients improve.