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{{Blastomycosis}}
{{Blastomycosis}}
{{CMG}}


{{SK}} North American blastomycosis; Gilchrist's disease
{{About1|Blastomyces Dermatitidis}}
'''For patient information on this page, click [[Blastomycosis (patient information)|here]]'''


'''Blastomycosis''' is a fungal infection caused by the organism ''[[Blastomyces dermatitidis]]''. [[Endemic (epidemiology)|Endemic]] to portions of North America, blastomycosis causes clinical symptoms similar to [[histoplasmosis]].<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = pp.676&ndash;8 |publisher = McGraw Hill | year = 2004 | id = ISBN 0838585299 }}</ref>
{{CMG}}; {{AE}}; {{VB}}; {{ADG}}


==History==
{{SK}} North American blastomycosis; Gilchrist's disease; Blastomyces dermatidis; Blastomycotic infection; Infection by Blastomyces; Chicago's disease
==[[Blastomycosis overview|Overview]]==


Blastomycosis was first described by Thomas Casper Gilchrist [http://www.whonamedit.com/doctor.cfm/2763.html] in 1894 and sometimes goes by the eponym ''Gilchrist's disease'' [http://www.whonamedit.com/synd.cfm/3327.html]. It is also sometimes referred to as Chicago Disease.
==[[Blastomycosis historical perspective|Historical Perspective]]==


<gallery>
==[[Blastomycosis classification|Classification]]==
Image:<img src="http://www.photogravure.com/photogravure_images/large/Ulmann_03_32.jpg|Thomas Casper Gilchrist">


</gallery>
==[[Blastomycosis pathophysiology|Pathophysiology]]==


==Epidemiology==
==[[Blastomycosis causes|Causes]]==


In the United States, blastomycosis is endemic in the Mississippi river and Ohio river basins and around the Great Lakes. The annual incidence is less than 1 case per 100,000 people in Mississippi, Louisiana, Kentucky, and Arkansas. The cases are greater in northern states such as Wisconsin, where from 1986 to 1995 there were 1.4 cases per 100,000 people.<ref>{{cite journal |author= |title=Blastomycosis--Wisconsin, 1986-1995 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=45 |issue=28 |pages=601-3 |year=1996 |pmid=8676851 |doi=}}</ref>
==[[Blastomycosis differential diagnosis|Differentiating Blastomycosis from other Diseases]]==


In Canada, most cases of blastomycosis occur in northwestern Ontario, particularly around the Kenora, Ontario area. The moist, acidic soil in the surrounding woodland harbors the fungus.
==[[Blastomycosis epidemiology and demographics|Epidemiology and Demographics]]==


Blastomycosis is distributed internationally; cases are sometimes reported from Africa.<ref name = Alvarez_2006>{{cite journal |author=Alvarez G, Burns B, Desjardins M, Salahudeen S, AlRashidi F, Cameron D |title=Blastomycosis in a young African man presenting with a pleural effusion |journal=Can Respir J |volume=13 |issue=8 |pages=441-4 |year=2006 |pmid=17149463}}</ref>
==[[Blastomycosis risk factors|Risk Factors]]==


==Pathology==
==[[Blastomycosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


Infection occurs by inhalation of the fungus from its natural soil habitat. Once inhaled in the lungs, they multiply and may disseminate through the blood and lymphatics to other organs, including the skin, bone, genitourinary tract, and brain. The incubation period is 30 to 100 days, although infection can be asymptomatic.
==Diagnosis==
[[Blastomycosis history and symptoms|History and Symptoms]] | [[Blastomycosis physical examination|Physical Examination]] | [[Blastomycosis laboratory findings|Laboratory Findings]] | [[Blastomycosis chest x ray|Chest X Ray]] | [[Blastomycosis CT|CT]] | [[Blastomycosis other diagnostic studies|Other Diagnostic Studies]]


==Clinical features==
==Treatment==
[[Image:Blastomycosis of skin.jpg|left|thumb|Blastomycosis of skin]]
[[Blastomycosis medical therapy|Medical Therapy]] | [[Blastomycosis surgery|Surgery]] | [[Blastomycosis primary prevention|Primary Prevention]] | [[Blastomycosis secondary prevention|Secondary Prevention]] | [[Blastomycosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Blastomycosis future or investigational therapies|Future or Investigational Therapies]]
'''Blastomycosis''' can present in one of the following ways:
*a flulike illness with fever, chills, myalgia, headache, and a nonproductive cough which resolves within days.
*an acute illness resembling bacterial [[pneumonia]], with symptoms of high fever, chills, a productive cough, and pleuritic chest pain.
*a chronic illness that mimics tuberculosis or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, and weight loss.
*a fast, progressive, and severe disease that manifests as [[ARDS]], with fever, shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates.
*skin lesions, usually asymptomatic, appear as ulcerated lesions with small pustules at the margins
*bone lytic lesions can cause bone or joint pain.
*prostatitis may be asymptomatic or may cause pain on urinating.
*laryngeal involvement causes hoarseness.


===Diagnosis===
==Case Studies==
Once suspected, the diagnosis of '''blastomycosis''' can usually be confirmed by demonstration of the characteristic broad based budding organisms in  sputum or tissues by KOH prep, cytology, or histology. Tissue biopsy of skin or other organs may be required in order to diagnose extra-pulmonary disease.  Commercially available urine antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where the organism is not readily detected. While culture of the organism remains the definitive diagnostic standard, its slow growing nature can lead to delays in treatment of up to several weeks.
[[Blastomycosis case study one|Case #1]]
 
However, sometimes blood and sputum cultures may not detect blastomycosis; lung biopsy is another option, and results will be shown promptly.
 
===Treatment===
[[Itraconazole]] given orally is the treatment of choice for most forms of the disease.  Cure rates are high, and the treatment over a period of months is usually well tolerated. [[Amphotericin B]] is considerably more toxic, and is usually reserved for critically ill patients and those with central nervous system disease.
 
===Prognosis===
Mortality rate in treated cases
*0-2% in treated cases among immunocompetent patients
*29% in immunocompromised patients
*40% in the subgroup of patients with AIDS
*68% in patients presenting as [[acute respiratory distress syndrome]] ([[ARDS]])


==Related Chapters==
==Related Chapters==
* [[Histoplasmosis]]
* [[Histoplasmosis]]
* [[Paracoccidioidomycosis]]
* [[Paracoccidioidomycosis]]
==References==
{{Reflist|2}}


{{Mycoses}}
{{Mycoses}}


[[Category:Fungal diseases]]
[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Pulmonology]]


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Latest revision as of 20:37, 29 July 2020

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This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Blastomyces Dermatitidis.

For patient information on this page, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]; Aditya Ganti M.B.B.S. [3]

Synonyms and keywords: North American blastomycosis; Gilchrist's disease; Blastomyces dermatidis; Blastomycotic infection; Infection by Blastomyces; Chicago's disease

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Blastomycosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

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