Blastomycosis history and symptoms: Difference between revisions
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{{CMG}}; {{AE}}; {{VB}} {{ADG}} | {{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== | ==Symptoms== | ||
Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms | Clinical manifestations of Blastomycosis range from [[subclinical infection]] to [[Disseminated disease|fatal disseminated disease]]. Symptoms are based on the involvement of organ systems: | ||
=== | ===Pulmonary Blastomycosis=== | ||
Presents clinically as acute and chronic. | 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> | ||
==== | *[[Fever]] with chills | ||
* | *[[Productive cough]] | ||
* | *[[Hemoptysis|Hemoptysis.]] | ||
* | *[[Weight loss]] | ||
*[[Night sweats]] | |||
* | *[[Pleuritic chest pain|chest pain]] | ||
* | *[[Acute respiratory distress syndrome|ARDS]] can develop as a result of endo-bronchial spread of infection which is dreadful complication with high [[mortality rate]]. | ||
* | |||
===Extra-Pulmonary blastomycosis=== | ===Extra-Pulmonary blastomycosis=== | ||
The most common extra pulmonary sites involved in blastomycosis are [[skin]], [[bone]], [[Genitourinary system|genitourinary]] and [[CNS]]. | |||
===Cutaneous blastomycosis=== | ====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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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
- 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 |
| |
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.