Blastomycosis history and symptoms: Difference between revisions
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====Oseous blastomycosis==== | ====Oseous blastomycosis==== | ||
* | *About 25% of the blastomycosis involve bone. | ||
*Osteomyelitis is the most common presentation of oseous blastomycosis. | |||
*Most commonly involved bones include Vertebrae, ribs, skull and long bones. | |||
*Infection cans spread from the involved bone to surrounding joints (purulent arthritis) or soft tissue (subcutaneous abscess with draining sinus wichh can lead to the formation of an ulcer) | |||
*The most common complication of vertebral osteomyelitis is extension of infection from the spine, resulting paravertebral or psoas abscess. | |||
====Genito-urinary==== | |||
*About 10 % of the blastomycosis involves genitourinary system. | |||
*In Men the most commonly involved organs include prostrate, 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. | |||
*CSF analysis of WBC reveals neturophilic predominance. | |||
* A flu like illness with fever, chills, [[myalgia]], headache, and a nonproductive cough which resolves within days. | * A flu like illness with fever, chills, [[myalgia]], headache, and a nonproductive cough which resolves within days. | ||
Revision as of 20:06, 27 February 2017
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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]
Symptoms
Clinical manifestations of Blastomycosis range from subclinical infection to fatal disseminated disease. Symptoms can be discussed under pulmonary and extra-pulmonary presentations.
Pulmunory Blastomycosis
Presents clinically as acute and chronic.
Acute
- The symptoms mimic with acute bacterial pneumonia presentation
- Presents with fever, chills, productive cough, with or without hemoptysis.
- Often self limited
Chronic
- Symptoms last for more that 2 months
- Presents with weight loss, fever, night sweats, cough with sputum, and chest pain
- This presentation can be confused with pulmonary tuberculosis, malignancy of lung
- ARDS can develop as a result of endobronchial 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, CNS.
Cutaneous blastomycosis
- Skin is involved in 40-80% of the cases.
- The cutaneous manifestations of blastomycosis comes in two forms verrucous and ulcerative.
| Verrucous | Ulcerative | |
|---|---|---|
| Location | Above the subcutaneous abscess | Drainout 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.
- Most commonly involved bones include Vertebrae, ribs, skull and long bones.
- Infection cans spread from the involved bone to surrounding joints (purulent arthritis) or soft tissue (subcutaneous abscess with draining sinus wichh can lead to the formation of an ulcer)
- The most common complication of vertebral osteomyelitis is extension of infection from the spine, resulting paravertebral or psoas abscess.
Genito-urinary
- About 10 % of the blastomycosis involves genitourinary system.
- In Men the most commonly involved organs include prostrate, 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.
- CSF analysis of WBC reveals neturophilic predominance.
- A flu like 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 pleuritis.
- 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.
- A fast, progressive, and severe disease that manifests as Acute respiratory distress syndomeARDS, 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 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).
- 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.
- Prostatitis in men may be asymptomatic e or may cause pain on urinating, in women genito-urinary system involvement can lead to tubo-ovarian abscess or endometritis.
- Laryngeal involvement causes hoarseness.
- 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.[1]