Blastomycosis history and symptoms
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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.[1]
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, genitourinary and CNS.
Cutaneous blastomycosis
- Skin is involved in 40-80% of the cases.[2]
- The cutaneous manifestations of blastomycosis comes in two forms verrucous and ulcerative.[3]
- Cutaneous blastomycosis is often confused with basal cell or squamous cell carcinomas or pyoderma gangrenosum.
| 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.[4]
- CSF analysis of WBC reveals neturophilic predominance.
- Laryngeal involvement causes hoarseness.
Other sites of disease
Blastomycosis can disseminate almost to any other site such as liver, spleen, breast, lymph nodes etc.[5]
References
- ↑ 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.
- ↑ Smith, Jeannina; Gauthier, Greg (2015). "New Developments in Blastomycosis". Seminars in Respiratory and Critical Care Medicine. 36 (05): 715–728. doi:10.1055/s-0035-1562898. ISSN 1069-3424.
- ↑ Kauffman, Carol (2011). Essentials of clinical mycology. New York: Springer. ISBN 978-1-4419-6639-1.
- ↑ Bariola, J. Ryan; Perry, Paul; Pappas, Peter G.; Proia, Laurie; Shealey, Wesley; Wright, Patty W.; Sizemore, James M.; Robinson, Matthew; Bradsher, Robert W. (2010). "Blastomycosis of the Central Nervous System: A Multicenter Review of Diagnosis and Treatment in the Modern Era". Clinical Infectious Diseases. 50 (6): 797–804. doi:10.1086/650579. ISSN 1058-4838.
- ↑ Saccente, M.; Woods, GL. (2010). "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMID 20375357. Unknown parameter
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