Blastomycosis history and symptoms: Difference between revisions

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Latest revision as of 20:37, 29 July 2020

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]

Overview

Patients with blastomycosis may present with any of several patterns of illness from a flu like illness which resolves within days to asymptomatic presentation (30-50%). Because of the brief and self-limited nature of these symptoms, blastomycosis may go un-diagnosed. Alternatively, patients may present with an acute illness mimicking bacterial pneumonia, with high fever, chills, a productive cough, and pleuritic chest pain which in most cases gets treated with antibiotics. ARDS is the most feared complication of the chronic blastomycosis. Dissemination through blood or lymph can result in extra pulmonary blastomycosis, which commonly involves skin, bone, genitourinary system and central nervous system.

History

The significant information that needs to focused in the history of the patient includes

Any history of travel to the endemic areas
Any ill contact with similar complaints

Symptoms

Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms are based on the involvement of organ systems:

Pulmonary Blastomycosis

Presents clinically as acute and chronic. The symptoms often mimic with bacterial pneumonia presentation. Most common symptoms include : ^[1]

Fever with chills
Productive cough
Hemoptysis.
Weight loss
Night sweats
chest pain
ARDS can develop as a result of endo-bronchial spread of infection which is dreadful complication with high mortality rate.

Extra-Pulmonary blastomycosis

The most common extra pulmonary sites involved in blastomycosis are skin, bone, genitourinary and CNS.

Cutaneous blastomycosis

Skin is involved in 40-80% of the cases.^[2]

The cutaneous manifestations of blastomycosis comes in two forms verrucous and ulcerative.^[3]
Cutaneous blastomycosis is often confused with basal cell or squamous cell carcinomas or pyoderma gangrenosum.

	Verrucous	Ulcerative
Location	Above the subcutaneous abscess	Drain-out from subcutaneous abscess through skin
Morphology	Irregularly shaped lesions with raised and crusted borders	Heaped up borders with or without exudative base
Microscopic findings	Papillomatosis Pseudo epitheliomatous hyperplasia Acanthosis (hyperplasia and diffuse thickening of the stratum spinosum of the epidermis) Micro-abscesses

Oseous blastomycosis

About 25% of the blastomycosis involve bone.
Osteomyelitis is the most common presentation of oseous blastomycosis.^[4]
Most commonly involved bones include vertebrae, ribs, skull and long bones.^[5]
Infection can spread from the involved bone to surrounding joints (purulent arthritis) or soft tissue (subcutaneous abscess with draining sinus which can lead to the formation of an ulcer.^[5]
The most common complication of vertebral osteomyelitis is extension of infection from the spine, resulting para-vertebral or psoas abscess.

Genito-urinary

About 10 % of the blastomycosis involves genitourinary system.
In men the most commonly involved organs include prostate, testicles and epididymis.
Epididymo-orchitis causes swelling and pain, and prostatitis is associated with dysuria and symptoms of obstruction.
Involvement of female genitourinary system is rare but if involved it causes endometrial infection or tubo-ovarian abscess.

Central nervous system

About 5-10 % of blastomycosis involve CNS.
It presents as meningitis or mass lesion.^[6]
CSF analysis of WBC reveals neutrophilic predominance.^[7]
Laryngeal involvement causes hoarseness.

Other sites of disease

Blastomycosis can disseminate almost to any other site such as liver, spleen, breast, lymph nodes etc.^[8]

References

↑ Smith JA, Gauthier G (2015). "New Developments in Blastomycosis". Semin Respir Crit Care Med. 36 (5): 715–28. doi:10.1055/s-0035-1562898. PMID 26398538.
↑ Smith, Jeannina; Gauthier, Greg (2015). "New Developments in Blastomycosis". Seminars in Respiratory and Critical Care Medicine. 36 (05): 715–728. doi:10.1055/s-0035-1562898. ISSN 1069-3424.
↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
↑ CARNESALE PL, STEGMAN KF (1956). "Blastomycosis of bone; report of four cases". Ann. Surg. 144 (2): 252–7. PMC 1465309. PMID 13355200.
↑ ^5.0 ^5.1 Sanders, Louis L. (1967). "Blastomycosis arthritis". Arthritis & Rheumatism. 10 (2): 91–98. doi:10.1002/art.1780100203. ISSN 0004-3591.
↑ Bariola, J. Ryan; Perry, Paul; Pappas, Peter G.; Proia, Laurie; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W. (2010). "Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era". Clinical Infectious Diseases. 50 (6): 797–804. doi:10.1086/650579. ISSN 1058-4838.
↑ Harley WB, Lomis M, Haas DW (1994). "Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review". Clin. Infect. Dis. 18 (5): 816–8. PMID 8075280.
↑ Saccente, M.; Woods, GL. "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMID 20375357.

Template:WS

[pmid26398538-1] Smith JA, Gauthier G (2015). "New Developments in Blastomycosis". Semin Respir Crit Care Med. 36 (5): 715–28. doi:10.1055/s-0035-1562898. PMID 26398538.

[SmithGauthier2015-2] Smith, Jeannina; Gauthier, Greg (2015). "New Developments in Blastomycosis". Seminars in Respiratory and Critical Care Medicine. 36 (05): 715–728. doi:10.1055/s-0035-1562898. ISSN 1069-3424.

[3] Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.

[pmid13355200-4] CARNESALE PL, STEGMAN KF (1956). "Blastomycosis of bone; report of four cases". Ann. Surg. 144 (2): 252–7. PMC 1465309. PMID 13355200.

[Sanders1967-5] 5.0 ^5.1 Sanders, Louis L. (1967). "Blastomycosis arthritis". Arthritis & Rheumatism. 10 (2): 91–98. doi:10.1002/art.1780100203. ISSN 0004-3591.

[BariolaPerry2010-6] Bariola, J. Ryan; Perry, Paul; Pappas, Peter G.; Proia, Laurie; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W. (2010). "Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era". Clinical Infectious Diseases. 50 (6): 797–804. doi:10.1086/650579. ISSN 1058-4838.

[pmid8075280-7] Harley WB, Lomis M, Haas DW (1994). "Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review". Clin. Infect. Dis. 18 (5): 816–8. PMID 8075280.

[Saccente-2010-8] Saccente, M.; Woods, GL. "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMID 20375357.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

@@ Line 3: / Line 3: @@
 {{CMG}}; {{AE}}; {{VB}} {{ADG}}
+==Overview==
+Patients with [[blastomycosis]] may present with any of several patterns of illness from a [[Influenza-like illness|flu like illness]] which resolves within days to asymptomatic presentation (30-50%). Because of the brief and self-limited nature of these symptoms, blastomycosis may go un-diagnosed. Alternatively, patients may present with an acute illness mimicking [[bacterial pneumonia]], with [[High fever|high feve]]<nowiki/>r, [[chills]], a [[productive cough]], and [[pleuritic chest pain]] which in most cases gets treated with [[antibiotics]]. [[Acute respiratory distress syndrome|ARDS]] is the most feared complication of the chronic blastomycosis. Dissemination through [[blood]] or [[lymph]] can result in extra [[pulmonary]] blastomycosis, which commonly involves [[skin]], [[bone]], [[genitourinary system]] and [[central nervous system]].
+==History==
+The significant information that needs to focused in the history of the patient includes
+*Any history of travel to the endemic areas
+*Any ill contact with similar complaints
 ==Symptoms==
-[[Image:Blastomycosis of skin.jpg|left|thumb|350px|Blastomycosis of skin]]
+Clinical manifestations of Blastomycosis range from [[subclinical infection]] to [[Disseminated disease|fatal disseminated disease]]. Symptoms are based on the involvement of organ systems:
-Blastomycosis can present in one of the following ways:
+===Pulmonary Blastomycosis===
-* A flu like illness with fever, chills, [[myalgia]], headache, and a nonproductive cough which resolves within days.
+Presents clinically as acute and chronic. The symptoms often mimic with [[bacterial pneumonia]] presentation. Most common symptoms include : <ref name="pmid26398538">{{cite journal |vauthors=Smith JA, Gauthier G |title=New Developments in Blastomycosis |journal=Semin Respir Crit Care Med |volume=36 |issue=5 |pages=715–28 |year=2015 |pmid=26398538 |doi=10.1055/s-0035-1562898 |url=}}</ref>
-* An acute illness resembling bacterial [[pneumonia]], with symptoms of high fever, chills, a productive cough, and [[pleuritis]].
+*[[Fever]] with chills
-* A chronic illness that mimics tuberculosis, other fungal infections or lung cancer, with symptoms of low-grade fever, a productive cough, [[night sweats]], hemoptysis and weight loss.
+*[[Productive cough]]
-* A fast, progressive, and severe disease that manifests as Acute respiratory distress syndome[[ARDS]], with fever, [[shortness of breath]], [[tachypnea]], [[hypoxemia]], and diffuse pulmonary infiltrates.
+*[[Hemoptysis|Hemoptysis.]]
-* Skin lesions, usually asymptomatic, appear as ulcerated lesions with small pustules at the margins or they can be verrucous with irregular margins, and color ranging from gray to violet. Skin lesions are usually a result of hematogenous spread but sometimes they can be inoculated directly due to animal bite (pet dogs).
+*[[Weight loss]]
-* Bone lesions can lead to [[osteomyelitis]], which can damage underlying bone and overlying skin leading to discharging sinuses. It presents with fever, bone pain, etc. Acute or chronic [[arthritis]] can develop due to underlying osteomyelitis.
+*[[Night sweats]]
-* [[Prostatitis]] in men may be asymptomatic or may cause [[pain]] on urinating, in women genito-urinary system involvement can lead to [[tubo-ovarian abscess]] or [[endometritis]].
+*[[Pleuritic chest pain|chest pain]]
-* Laryngeal involvement causes [[hoarseness]].
+*[[Acute respiratory distress syndrome|ARDS]] can develop as a result of endo-bronchial spread of infection which is dreadful complication with high [[mortality rate]].
-* CNS(central nervous system) involvement can lead to meningtis, abscess, which can lead to [[focal neurological deficit]]'s.
-* Blastomycosis can include almost any other site such as liver, spleen, breast, lymph nodes etc.<ref name="Saccente-2010">{{Cite journal  | last1 = Saccente | first1 = M. | last2 = Woods | first2 = GL. | title = Clinical and laboratory update on blastomycosis. | journal = Clin Microbiol Rev | volume = 23 | issue = 2 | pages = 367-81 | month = Apr | year = 2010 | doi = 10.1128/CMR.00056-09 | PMID = 20375357 }}</ref>
+===Extra-Pulmonary blastomycosis===
+The most common extra pulmonary sites involved in blastomycosis are [[skin]], [[bone]], [[Genitourinary system|genitourinary]] and [[CNS]].
+====Cutaneous blastomycosis====
+*[[Skin]] is involved in 40-80% of the cases.<ref name="SmithGauthier2015">{{cite journal|last1=Smith|first1=Jeannina|last2=Gauthier|first2=Greg|title=New Developments in Blastomycosis|journal=Seminars in Respiratory and Critical Care Medicine|volume=36|issue=05|year=2015|pages=715–728|issn=1069-3424|doi=10.1055/s-0035-1562898}}</ref>
+*The [[cutaneous]] manifestations of blastomycosis comes in two forms verrucous and ulcerative.<ref>{{cite book | last = Kauffman | first = Carol | title = Essentials of clinical mycology | publisher = Springer | location = New York | year = 2011 | isbn = 978-1-4419-6639-1 }}</ref>
+*Cutaneous blastomycosis is often confused with [[Basal cell carcinoma|basal cell]] or [[Squamous cell carcinoma|squamous cell carcinomas]] or [[pyoderma gangrenosum]].
+{| class="wikitable"
+!
+!Verrucous
+!Ulcerative
+|-
+|'''Location'''
+|Above the [[Subcutaneous|subcutaneous abscess]]
+|Drain-out from [[subcutaneous]] [[abscess]] through [[skin]]
+|-
+|'''Morphology'''
+|Irregularly shaped [[lesions]] with raised and crusted borders
+|Heaped up borders with or without [[Exudative|exudative base]]
+|-
+|'''Microscopic'''
+'''findings'''
+| colspan="2" |
+* [[Papillomatosis]]
+* Pseudo epitheliomatous [[hyperplasia]]
+* Acanthosis ([[hyperplasia]] and diffuse thickening of the [[stratum spinosum]] of the epidermis)
+* Micro-abscesses
+|}
+====Oseous blastomycosis====
+*About 25% of the blastomycosis involve bone.
+*[[Osteomyelitis]] is the most common presentation of oseous blastomycosis.<ref name="pmid13355200">{{cite journal |vauthors=CARNESALE PL, STEGMAN KF |title=Blastomycosis of bone; report of four cases |journal=Ann. Surg. |volume=144 |issue=2 |pages=252–7 |year=1956 |pmid=13355200 |pmc=1465309 |doi= |url=}}</ref>
+*Most commonly involved bones include [[vertebrae]], [[ribs]], [[skull]] and [[long bones]].<ref name="Sanders1967">{{cite journal|last1=Sanders|first1=Louis L.|title=Blastomycosis arthritis|journal=Arthritis & Rheumatism|volume=10|issue=2|year=1967|pages=91–98|issn=00043591|doi=10.1002/art.1780100203}}</ref>
+*[[Infection]] can spread from the involved bone to surrounding [[joints]] ([[Septic arthritis|purulent arthritis]]) or [[soft tissue]] ([[subcutaneous]] [[abscess]] with draining [[sinus]] which can lead to the formation of an [[ulcer]].<ref name="Sanders1967">{{cite journal|last1=Sanders|first1=Louis L.|title=Blastomycosis arthritis|journal=Arthritis & Rheumatism|volume=10|issue=2|year=1967|pages=91–98|issn=00043591|doi=10.1002/art.1780100203}}</ref>
+*The most common complication of [[vertebral osteomyelitis]] is extension of [[infection]] from the [[spine]], resulting para-vertebral or [[Psoas abscess|psoas abscess.]]
+====Genito-urinary====
+*About 10 % of the blastomycosis involves [[genitourinary system]].
+*In men the most commonly involved organs include [[prostate]], [[testicles]] and [[epididymis]].
+*[[Epididymo-orchitis]] causes [[swelling]] and [[pain]], and [[prostatitis]] is associated with [[dysuria]] and symptoms of [[obstruction]].
+*Involvement of female genitourinary system is rare but if involved it causes [[Endometritis|endometrial infection]] or [[tubo-ovarian abscess]].
+====Central nervous system====
+*About 5-10 % of blastomycosis involve CNS.
+*It presents as [[meningitis]] or mass lesion.<ref name="BariolaPerry2010">{{cite journal|last1=Bariola|first1=J. Ryan|last2=Perry|first2=Paul|last3=Pappas|first3=Peter G.|last4=Proia|first4=Laurie|last5=Shealey|first5=Wesley|last6=Wright|first6=Patty W.|last7=Sizemore|first7=James M.|last8=Robinson|first8=Matthew|last9=Bradsher|first9=Robert W.|title=Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era|journal=Clinical Infectious Diseases|volume=50|issue=6|year=2010|pages=797–804|issn=1058-4838|doi=10.1086/650579}}</ref>
+*[[CSF analysis]] of [[WBC]] reveals [[Neutrophilia|neutrophilic predominance]].<ref name="pmid8075280">{{cite journal |vauthors=Harley WB, Lomis M, Haas DW |title=Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: case report and review |journal=Clin. Infect. Dis. |volume=18 |issue=5 |pages=816–8 |year=1994 |pmid=8075280 |doi= |url=}}</ref>
+* [[Laryngeal|Laryngea]]<nowiki/>l involvement causes [[hoarseness]].
+====Other sites of disease====
+Blastomycosis can disseminate almost to  any other site such as [[liver]], [[spleen]], [[breast]], [[lymph nodes]] etc.<ref name="Saccente-2010">{{Cite journal  | last1 = Saccente | first1 = M. | last2 = Woods | first2 = GL. | title = Clinical and laboratory update on blastomycosis. | journal = Clin Microbiol Rev | volume = 23 | issue = 2 | pages = 367-81 | doi = 10.1128/CMR.00056-09 | PMID = 20375357 }}</ref>
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