Blastomycosis physical examination: Difference between revisions

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==Overview==
==Overview==
The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are : lungs, skin, bones, genitourinary system, central nervous system and other misc organs.
The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are [[lungs]], [[skin]], [[bones]], [[genitourinary system]], [[central nervous system]] and other organs.


==Physical Examination==
==Physical Examination==
===Vital Signs===
===Vital Signs===
*[[Fever]] <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>
*[[Tachypnea]]
===Oral cavity===
===Oral cavity===
 
*[[Oral ulcers]] can be seen in some patients
=====Gallery=====
===Lymph nodes===
<gallery>
*In cases with [[skin]] involvement from direct [[inoculation]], regiona[[Lymphadenopathy|l lymph node enlargement]] may be seen.
 
===Neck===  
Image:South_american_blastomycosis_05.jpg |Keloidal blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
*No masses
 
===Cardiovascular system===
Image:Keloidal_blastomycosis 01.jpg|Keloidal blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
*Regular rate and rhythm
 
*[[Heart sounds|Normal S1, S2]]
Image:Keloidal_blastomycosis 02.jpg|Keloidal blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
*No [[murmurs]], rubs, or [[Gallops and Extra Heart Sounds|gallops]]
 
Image:Keloidal_blastomycosis 03.jpg|Keloidal blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
 
Image:Keloidal_blastomycosis 04.jpg|Keloidal blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
 
 
Image: Blastomycosis35.jpeg|Nodular skin lesions of blastomycosis, one of which is a bullous lesion on top of a nodule. <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>
 
Image: Blastomycosis01.png| Fungal infection of the face affecting his right eye, upper lip, nares, and tongue. Brazilian blastomycosis, is caused by the fungal organism, Paracoccidioides brasiliensis. <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>
</gallery>
===Lungs===
===Lungs===
 
Findings consistent with [[Consolidation (medicine)|parenchymal consolidation]] such as<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>
Findings consistent with parenchymal consolidation such as
*[[Percussion of the lungs|Dullness to percussion]]
*dullness to percussion
*Increased [[fremitus]]
*increased fremitus  
*Signs of [[pleura]] involvement such as [[pleuritic]] rub.
*Signs of pleura involvement such as pleuritic rub can be found.
===Abdominal===
*[[Abdomen]] soft and non-distended with no [[scars]] or striations
*No pulsatile [[Mass|masses]] or [[Abdominal bruit|abdominal bruits]] ascultated
*[[Spleen]] not palpable, [[liver]] not palpable


===Skin===
===Skin===


*Ulcerative lesions that bleed easily and verrucous lesions with irregular border and variegated appearance are the two most common findings of cutaneous involvement.
*Ulcerative lesions that bleed easily  
*In cases with skin involvement from inoculation regional lymph node enlargement may be seen.
*Verrucous lesions with irregular border and variegated appearance
 


===Bone and joints===
===Bone and joints===


*Soft tissue swelling around the area of involvement and discharging sinuses might be consistent with osteomyelitis.  
*[[Soft tissue]] [[swelling]] around the area of involvement and discharging [[sinuses]] might be consistent with [[osteomyelitis]].  
*Arthritis can cause reproducible pain in joints.  
*[[Arthritis]] can cause reproducible [[pain]] in [[joints]].  


===Genitourinary system===
===Genitourinary system===


[[Pyuria]] and painful urination may be the only signs consistent with genito-urinary involvement.
*[[Pyuria]]  
 
*[[Dysuria|Painful urination]]
Other physical findings depend on the specific site involved but involves only a minority of cases.


===Extremities===
===Extremities===
*[[Ulcers]] that bleed on touch
===Neurological===
Normal examination finding unless the infection is disseminated to brain resulting in meningitis,then findings include :
*[[Consciousness|Altered level of consciousness]]
*[[Nuchal rigidity]]


=====Gallery=====
=====Gallery=====
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<gallery>
<gallery>


Image:South_american_blastomycosis_06.jpg |South american blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
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>
 
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>
 
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>
 
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>


Image:South_american_blastomycosis_07.jpg |South american blastomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=55>
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>


</gallery>
</gallery>
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Latest revision as of 20:37, 29 July 2020

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

Overview

The physical manifestations of the disease depends on the organ of involvement. In the order of incidence the most commonly involved organs are lungs, skin, bones, genitourinary system, central nervous system and other organs.

Physical Examination

Vital Signs

Oral cavity

Lymph nodes

Neck

  • No masses

Cardiovascular system

Lungs

Findings consistent with parenchymal consolidation such as[2]

Abdominal

Skin

  • Ulcerative lesions that bleed easily
  • Verrucous lesions with irregular border and variegated appearance

Bone and joints

Genitourinary system

Extremities

Neurological

Normal examination finding unless the infection is disseminated to brain resulting in meningitis,then findings include :

Gallery

References

  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.
  2. ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 "Public Health Image Library (PHIL)".

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