Blastomycosis differential diagnosis

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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]

Overview

Acute pneumonia itself is a mild flu-like illness that needs to be differentiated from a number of other fungal/bacterial disorders. These disorders have overlapping signs & symptoms that often need detailed History, Physical examination and serological tests to pin-point the diagnosis. It can be often misinterpreted as community acquired pneumonia.

Fungal

• Coccidioidomycosis
• Histoplasmosis
• Aspergillosis
• Pneumocystis pneumonia
• Sporotrichosis

Bacterial

• Anthrax
• Legionella
• Listeriosis
• Brucellosis
• Tuberculosis
• Scrub typhus
• Leptospirosis
• Cat scratch fever

Viral

• Chickenpox
• Herpes(Prodrome)
• Influenza
• Parainfluenza
• HIV -1/-2
• Coxsackie B virus
• Hepatits
• Cytomegalovirus
• Eastern equine encephalitis virus
• Venezuelan equine encephalitis
• Coronavirus
• California Encephalitis virus

Chronic and disseminated disease

Disease	Differentiating Features	Differentiating Laboratory findings
Histoplasmosis	Palate and oral ulcers with spleenomegaly	Culture findings : yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages Pancytopenia Urine antigen testing
Coccidioidomycosis	Endemic to southwestern US region	Characteristic spherule appearance on culture media . Serologic tests( enzyme immune assay )more sensitive
Paracoccidioidomycosis	Lymphadenopathy, Hepatosplenomegaly, Bone marrow dysfunction Endemic to central and south america	Culture findings smaller fungi with thin cell walls, forming mariner wheel appearance, circumferentially surrounding the parent cell.
Sporotrichosis	Gardeners are at high risk Lymphadenitis (nodular, and subacute to chronic)	Biopsy of the skin confirms the diagnosis
Pulmonary Tuberculosis	No cutaneous involvement	Sputum positive for acid fast bacteria
Nocardiasis	Immunocompromised people worldwide distribution	Microscopic examination ; thin, branching gram-positive bacilli acid fast positive

Chronic blastomycosis may be initially confused with a malignancy or tuberculosis. While spread to other areas may be confused with malignancy as well. Skin lesions are often misdiagnosed as pyoderma gangreosum or keratoacanthoma. Therefore, a high index of suspicion is needed on the part of physician to diagnose blastomycosis.