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| __NOTOC__ | | __NOTOC__ |
| {{Blastomycosis}} | | {{Blastomycosis}} |
| {{CMG}}; {{AE}}; {{VB}} | | {{CMG}}; {{AE}}; {{VB}} {{ADG}} |
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| ==Overview== | | ==Overview== |
| 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]]. | | Once suspected, the diagnosis of blastomycosis can usually be confirmed by demonstration of the characteristic [[Budding|broad based budding organisms]] in [[sputum]] or [[tissues]] by [[KOH test|KOH prep]], [[cytology]], or [[histology]]. |
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| ==Laboratory Findings== | | ==Laboratory Findings== |
| Commonly performed tests include:
| | *Culture of the [[organism]] is the definitive [[diagnostic test]] in diagnosing blastomycosis, but due to slow growing nature of the [[organism]] it can delay in treatment up to several weeks. <ref name="pmid20375357">{{cite journal |vauthors=Saccente M, Woods GL |title=Clinical and laboratory update on blastomycosis |journal=Clin. Microbiol. Rev. |volume=23 |issue=2 |pages=367–81 |year=2010 |pmid=20375357 |pmc=2863359 |doi=10.1128/CMR.00056-09 |url=}}</ref> |
| * KOH preparation - shows a broad based budding yeast as shown in the microscopic picture above. sputum, blood, pleural and other body fluids may be used, however this process has a low clinical yield. | | *Culture on dextrose sabourd [[agar]] at 25 to 30°C for 4 to 6 weeks is normally employed. Highest diagnostic yield is of [[bronchoscopy]] derived [[fluid]], followed by sputum. |
| * Tissue [[biopsy]] of skin or other organs may be required in order to diagnose extra-pulmonary disease. A granulomatous inflammation might be suggestive of fungal presence but is not diagnostic. | | *Real time [[PCR]] is being experimentally tested for direct diagnosis from culture or tissue. <ref name="Sidamonidze-2012">{{Cite journal | last1 = Sidamonidze | first1 = K. | last2 = Peck | first2 = MK. | last3 = Perez | first3 = M. | last4 = Baumgardner | first4 = D. | last5 = Smith | first5 = G. | last6 = Chaturvedi | first6 = V. | last7 = Chaturvedi | first7 = S. | title = Real-time PCR assay for identification of Blastomyces dermatitidis in culture and in tissue. | journal = J Clin Microbiol | volume = 50 | issue = 5 | pages = 1783-6 | doi = 10.1128/JCM.00310-12 | PMID = 22403418 }}</ref> |
| | {| class="wikitable" |
| | !Infection |
| | !Specimen |
| | |- |
| | |[[Pneumonia]] |
| | |[[Sputum|Sputum,]] [[bronchoalveolar lavage]] |
| | |- |
| | |[[Cutaneous]] lesions |
| | |Deep [[tissue]] [[biopsy]], scrapings and [[exudate]] |
| | |- |
| | |Oseous lesions |
| | |Joint fluid, [[synovial]] [[tissue]] [[biopsy]] specimen |
| | |- |
| | |Genitourinary |
| | | |
| | [[Prostate]] biopsy specimen, [[urine]] |
| | |- |
| | |CNS |
| | |[[Cerebrospinal fluid]] |
| | |} |
| | *[[KOH test|KOH]] preparation - shows a broad based budding yeast multinucleate yeast cell, round to [[oval]], 8 to 15 μm in diameter with thick, refractile cell walls. [[Periodic acid-Schiff stain|Periodic acid-Schiff stain (PAS)]], PAS with [[Hematoxylin and eosin stain|hematoxylin counterstain]], and Grocott-Gomori's methenamine silver stain are some of the stains employed. |
| | * Tissue [[biopsy]] of [[skin]] or other [[organs]] may be required in order to diagnose extra-pulmonary disease. A [[granulomatous]] [[inflammation]] might be suggestive of [[fungal]] presence but is not diagnostic. |
| * Commercially available urine antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where the organism is not readily detected. It appears to be more helpful than serum antigen testing. | | * Commercially available urine antigen testing appears to be quite sensitive in suggesting the diagnosis in cases where the organism is not readily detected. It appears to be more helpful than serum antigen testing. |
| * 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. Culture on dextrose sabourd agar at 37ºC can be used for diagnosis. Highest diagnostic yield is of bronchoscopy derived fluid, followed by sputum. Real time [[PCR]] is being experimentally tested for direct diagnosis from culture or tissue. <ref name="Sidamonidze-2012">{{Cite journal | last1 = Sidamonidze | first1 = K. | last2 = Peck | first2 = MK. | last3 = Perez | first3 = M. | last4 = Baumgardner | first4 = D. | last5 = Smith | first5 = G. | last6 = Chaturvedi | first6 = V. | last7 = Chaturvedi | first7 = S. | title = Real-time PCR assay for identification of Blastomyces dermatitidis in culture and in tissue. | journal = J Clin Microbiol | volume = 50 | issue = 5 | pages = 1783-6 | month = May | year = 2012 | doi = 10.1128/JCM.00310-12 | PMID = 22403418 }}</ref>
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| * Serological testing is limited in utility by the fact that there is a considerable overlap with other fungal antigens.
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| However, sometimes blood and sputum cultures may not detect [[blastomycosis]]; lung biopsy is another option, and results will be shown promptly.
| | *[[Serological testing]] is limited in utility by the fact that there is a considerable overlap with other fungal antigens. |
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| ==Gallery==
| | *Sometimes [[blood]] and sputum cultures may not detect [[blastomycosis]], lung biopsy is another option, and results will be shown promptly. |
| <gallery>
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| Image: Blastomycosis02.jpeg| Ultrastructural histopathology in tissue specimen from a patient with a keloidean blastomycosis infection, which was caused by the fungus, Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis03.jpeg|Ultrastructural histopathology in a tissue specimen from a patient with a keloidean blastomycosis infection, which was caused by the fungus, Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis04.jpeg| Ultrastructural histopathology in a tissue specimen from a patient with a keloidean blastomycosis infection, which was caused by the fungus, Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis05.jpeg| H&E-stained photomicrograph reveals ultrastructural histopathology in an dermal skin tissue specimen in a patient with an intradermal keloidean blastomycosis infection, which was caused by the fungus, Blastomyces dermatitidis.<SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis08.jpeg| Morphologic changes that took place upon a patient’s arm, which included keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis09.jpeg| Morphologic changes that took place upon a patient’s arm, which included keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis10.jpeg| Ultrastructural histopathology in dermal skin tissue specimen in a patient with an intradermal keloidal blastomycosis infection. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis11.jpeg|Patient’s right knee revealed the keloidal scarring brought on due to a case of cutaneous blastomycosis, which was caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis13.jpeg| Patient’s right knee revealed the keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis15.jpeg|Patient’s right ankle displayed keloidal scarring brought on due to a case of cutaneous blastomycosis, caused by Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis16.jpeg| Ultrastructural details of Blastomyces dermatitidis including the organism’s aerial hypha, developing sporangia. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis17.jpeg|"Digested", and fluorescent antibody-stained photomicrograph reveals the presence of Blastomyces dermatitidis antigens in human lung tissue specimen (562x mag). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis18.jpeg| "Digested", and fluorescent antibody-stained photomicrograph reveals the presence of Blastomyces dermatitidis antigens in human lung tissue specimen (562x mag). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis20.jpeg| "Undigested", and fluorescent antibody-stained photomicrograph reveals presence of Blastomyces dermatitidis antigens in human lung tissue specimen (125x mag). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis21.jpeg|Gamori-stained photomicrograph of a canine liver tissue specimen, revealed the presence of budding Blastomyces dermatitidis fungal cells of various sizes (500x mag). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis22.jpeg| Fungal organism, Exophiala castellanii (1150x mag). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis25.jpeg| Note the histopathologic changes seen in blastomycosis due to Blastomyces dermatitidis using methenamine silver stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis26.jpeg| Note the histopathologic changes seen in blastomycosis due to Blastomyces dermatitidis using methenamine silver stain.<SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis27.jpeg| Direct FA stain revealing the histopathology of lung tissue blastomycosis due to the organism Blastomyces dermatitidis <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis28.jpeg| Direct FA stain revealing the histopathology of lung tissue blastomycosis due to the organism Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis29.jpeg| This is a photomicrograph of Blastomyces dermatitidis using a cotton blue staining technique. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis30.jpeg|This micrograph shows histopathologic changes that reveal the presence of the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis31.jpeg| This photomicrograph depicts the fungal agent Blastomyces dermatitidis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis32.jpeg|Histopathology of blastomycosis, lung of wolf. Yeast cells of Blastomyces dermatitidis. FA stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis33.jpeg|Histopathology of blastomycosis. Yeast cell of Blastomyces dermatitidis undergoing broad-base budding. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis34.jpeg|Histopathology of blastomycosis of skin. Budding cell of Blastomyces dermatitidis surrounded by neutrophils. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| Image: Blastomycosis37.jpeg|Smear from foot lesion of blastomycosis showing Blastomyces dermatitidis yeast cell undergoing broad-base budding. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| </gallery>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Fungal diseases]]
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