Blastomycosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Blastomycosis is a [[granulomatous]] disease entity, that can produce a wide array of signs and symptoms, but is usually a mild illness in many cases. The most common presentation is a mild acute pneumonia that is self resolving, it can also cause chronic pneumonia and extra-pulmonary manifestations. The most common site of involvement is lungs, but it can often spread to other sites such as skin, bones and genitourinary systems. The route of spread is most commonly either hematogenous or lymphatic. | Blastomycosis is a [[granulomatous]] disease entity, that can produce a wide array of signs and symptoms, but is usually a mild illness in many cases. The most common presentation is a [[Pneumonia|mild acute pneumonia]] that is self resolving, it can also cause chronic pneumonia and extra-pulmonary manifestations. The most common site of involvement is [[lungs]], but it can often spread to other sites such as [[skin]], [[bones]] and [[Genitourinary system|genitourinary systems]]. The route of spread is most commonly either hematogenous or lymphatic. | ||
==Natural history== | ==Natural history== | ||
*Symptoms of acute blastomycosis include an influenza like illness with fever, cough, myalgia, arthralgia, and pleurisy developing 3-15 weeks after exposure.<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> | *Symptoms of acute blastomycosis include an [[Influenza-like illness|influenza like illness]] with [[fever]], [[cough]], [[myalgia]], [[arthralgia]], and [[pleurisy]] developing 3-15 weeks after exposure.<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> | ||
*In most of the individuals the infection resolves spontaneously even without the treatment. | *In most of the individuals the infection resolves spontaneously even without the treatment. | ||
*But in some individuals with out treatment it may progress to a more chronic stage which confounds the diagnosis, mistaking it for tuberculosis, other fungal infections or even a malignancy. | *But in some individuals with out treatment it may progress to a more chronic stage which confounds the diagnosis, mistaking it for [[tuberculosis]], other fungal infections or even a [[Lung cancer|malignancy.]] | ||
*Patient may develop symptoms of high grade fever, productive cough, hemoptysis and weight loss. | *Patient may develop symptoms of [[High fever|high grade fever]], [[productive cough]], [[hemoptysis]] and [[weight loss]]. | ||
*A significant proportion of these cases may further disseminate to other body parts, most commonly to skin, followed by bone and joint, genitourinary system and other sites in the body. (Nervous system, lymphatics etc). | *A significant proportion of these cases may further disseminate to other body parts, most commonly to skin, followed by bone and joint, genitourinary system and other sites in the body. (Nervous system, lymphatics etc). | ||
*Leading to septicemia and finally death. | *Leading to [[septicemia]] and finally death. | ||
==Complications== | ==Complications== | ||
Complications that can develop as a result of | Complications that can develop as a result of Blastomycosis are : | ||
* Chronic pulmonary involvement leading to fibrosis. | * Chronic pulmonary involvement leading to [[fibrosis]]. | ||
* Cutaneous involvement can cause large [[sore]]s with [[pus]] ([[abscesses]]). | * Cutaneous involvement can cause large [[sore]]s with [[pus]] ([[abscesses]]). | ||
* Osteomyelitis from bone involvement.<ref name="Moore-1982">{{Cite journal | last1 = Moore | first1 = RM. | last2 = Green | first2 = NE. | title = Blastomycosis of bone. A report of six cases. | journal = J Bone Joint Surg Am | volume = 64 | issue = 7 | pages = 1097-101 | month = Sep | year = 1982 | doi = | PMID = 7118980 }}</ref> | * [[Osteomyelitis]] from bone involvement.<ref name="Moore-1982">{{Cite journal | last1 = Moore | first1 = RM. | last2 = Green | first2 = NE. | title = Blastomycosis of bone. A report of six cases. | journal = J Bone Joint Surg Am | volume = 64 | issue = 7 | pages = 1097-101 | month = Sep | year = 1982 | doi = | PMID = 7118980 }}</ref> | ||
* [[Prostatitis]] and [[epididymo-orchitis]] in males and [[tubo-ovarian abscess]] in females have been reported.<ref name="Eickenberg H-U-1975">{{Cite journal | last1 = Eickenberg H-U | first1 = M. | last2 = Amin | first2 = R. | last3 = Lich | first3 = . | title = Blastomycosis of the genitourinary tract. | journal = J Urol | volume = 113 | issue = 5 | pages = 650-2 | month = May | year = 1975 | doi = | PMID = 1173249 }}</ref><ref name="Seo-1997">{{Cite journal | last1 = Seo | first1 = R. | last2 = Oyasu | first2 = R. | last3 = Schaeffer | first3 = A. | title = Blastomycosis of the epididymis and prostate. | journal = Urology | volume = 50 | issue = 6 | pages = 980-2 | month = Dec | year = 1997 | doi = 10.1016/S0090-4295(97)00406-8 | PMID = 9426737 }}</ref> | * [[Prostatitis]] and [[epididymo-orchitis]] in males and [[tubo-ovarian abscess]] in females have been reported.<ref name="Eickenberg H-U-1975">{{Cite journal | last1 = Eickenberg H-U | first1 = M. | last2 = Amin | first2 = R. | last3 = Lich | first3 = . | title = Blastomycosis of the genitourinary tract. | journal = J Urol | volume = 113 | issue = 5 | pages = 650-2 | month = May | year = 1975 | doi = | PMID = 1173249 }}</ref><ref name="Seo-1997">{{Cite journal | last1 = Seo | first1 = R. | last2 = Oyasu | first2 = R. | last3 = Schaeffer | first3 = A. | title = Blastomycosis of the epididymis and prostate. | journal = Urology | volume = 50 | issue = 6 | pages = 980-2 | month = Dec | year = 1997 | doi = 10.1016/S0090-4295(97)00406-8 | PMID = 9426737 }}</ref> | ||
* Recurrence of the disease. | * Recurrence of the disease. | ||
* Side effects from the treatment drugs such as [[ | * Side effects from the treatment drugs such as [[Amphotericin B]] | ||
==Prognosis== | ==Prognosis== | ||
Mortality rate in treated cases | Extra-pulmonary manifestations usually require a longer overall duration of treatment. The cases that do relapse after treatment, usually respond well to a second treatment course. Mortality rate in treated cases | ||
* 0-2% in treated cases among immuno-competent patients | * 0-2% in treated cases among immuno-competent patients | ||
* 29% in immuno-compromised patients | * 29% in immuno-compromised patients | ||
* 40% in the subgroup of patients with AIDS | * 40% in the subgroup of patients with AIDS | ||
* 68% in patients presenting as [[acute respiratory distress syndrome]] ([[ARDS]]) | * 68% in patients presenting as [[acute respiratory distress syndrome]] ([[ARDS]]) | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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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
Blastomycosis is a granulomatous disease entity, that can produce a wide array of signs and symptoms, but is usually a mild illness in many cases. The most common presentation is a mild acute pneumonia that is self resolving, it can also cause chronic pneumonia and extra-pulmonary manifestations. The most common site of involvement is lungs, but it can often spread to other sites such as skin, bones and genitourinary systems. The route of spread is most commonly either hematogenous or lymphatic.
Natural history
- Symptoms of acute blastomycosis include an influenza like illness with fever, cough, myalgia, arthralgia, and pleurisy developing 3-15 weeks after exposure.[1]
- In most of the individuals the infection resolves spontaneously even without the treatment.
- But in some individuals with out treatment it may progress to a more chronic stage which confounds the diagnosis, mistaking it for tuberculosis, other fungal infections or even a malignancy.
- Patient may develop symptoms of high grade fever, productive cough, hemoptysis and weight loss.
- A significant proportion of these cases may further disseminate to other body parts, most commonly to skin, followed by bone and joint, genitourinary system and other sites in the body. (Nervous system, lymphatics etc).
- Leading to septicemia and finally death.
Complications
Complications that can develop as a result of Blastomycosis are :
- Chronic pulmonary involvement leading to fibrosis.
- Cutaneous involvement can cause large sores with pus (abscesses).
- Osteomyelitis from bone involvement.[2]
- Prostatitis and epididymo-orchitis in males and tubo-ovarian abscess in females have been reported.[3][4]
- Recurrence of the disease.
- Side effects from the treatment drugs such as Amphotericin B
Prognosis
Extra-pulmonary manifestations usually require a longer overall duration of treatment. The cases that do relapse after treatment, usually respond well to a second treatment course. Mortality rate in treated cases
- 0-2% in treated cases among immuno-competent patients
- 29% in immuno-compromised patients
- 40% in the subgroup of patients with AIDS
- 68% in patients presenting as acute respiratory distress syndrome (ARDS)
References
- ↑ Saccente M, Woods GL (2010). "Clinical and laboratory update on blastomycosis". Clin. Microbiol. Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMC 2863359. PMID 20375357.
- ↑ Moore, RM.; Green, NE. (1982). "Blastomycosis of bone. A report of six cases". J Bone Joint Surg Am. 64 (7): 1097–101. PMID 7118980. Unknown parameter
|month=ignored (help) - ↑ Eickenberg H-U, M.; Amin, R.; Lich, . (1975). "Blastomycosis of the genitourinary tract". J Urol. 113 (5): 650–2. PMID 1173249. Unknown parameter
|month=ignored (help) - ↑ Seo, R.; Oyasu, R.; Schaeffer, A. (1997). "Blastomycosis of the epididymis and prostate". Urology. 50 (6): 980–2. doi:10.1016/S0090-4295(97)00406-8. PMID 9426737. Unknown parameter
|month=ignored (help)