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Fungal Infections

Disease name and synonyms

Blastomycosis

Fungi responsible (links to these)

Blastomyces dermatitidis

Disease description

After inhalation, primary pulmonary infection follows. Cutaneous and bone lesions indicate dissemination. Meningitis occurs in <5% of immunocompetent patients. The disease is usually relatively indolent. Occasionally rapidly progressive pneumonia leading to the adult respiratory distress syndrome is seen, which is more common in AIDS.  Blastomycosis in AIDS and other immunocompromised patients has a more rapid course, and a much higher frequency of CNS involvement, usually as a brain abscess.

Frequency and global burden

Blastomycosis is endemic to North America and has been noted occasionally in Africa and India. Studies performed in the USA showed that the incidence of this infection is between 0.5-to 7-cases/100.000 people. Contact rates with the fungus Are probably much higher.

Underlying problems and at risk patients

Most affected patients were healthy adults, particularly middle aged men undertaking sports or work in rural or wild areas. Immunocompromised patients are at increased risk of severe disease.

Diagnostic testing

Culture of the organism from sputum or (skin) biopsy material. The histological appearance of B. dermatitidis is distinctive with yeasts cells with broad-based budding, unlike C. neoformans in which the budding is from a narrow base. An antigen test is available in one US laboratory.

Treatment

Itraconazole is highly effective in non-immunocompromised patients. Bone and joint disease require 12 months of therapy. Amphotericin B is preferred in patients with severe pulmonary or brain infection, or immunocompromised patients with disseminated disease.

IDSA clinical practice guidelines 2008

Outlook and prognosis

In non-immunocompromised patients cure rates of 95% are typical. Outcomes are good even in very ill patients, if the diagnosis is made early and amphotericin B therapy initiated.

Images

BlastomycosisaBlastomycosisb

a. Primary pulmonary blastomycosis with left and lower mid zone peripheral consolidation b. Skin lesions of blastomycosis occurring along a scar line (Koebner phenomonen).

Blastomycosis

Cutaneous blastomycosis on her nose in a woman from the Midwest USA, who received itraconazole for 6 months and responded well (right image).

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