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] Aditya Ganti M.B.B.S. [3]

Overview

Blastomycosis have overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed History, Physical examination and serological tests helps us to pin-point the diagnosis. All this disorders can be often misinterpreted as community acquired pneumonia as they all present with similar complaints such as fever, productive cough, chest pain and shortness of breath. The following table elaborates differentiating features between blastomycosis from other fungal disorders.

Fungal

	Disease	Geographic distribution	High risk Groups	Differentiating Features	Microscopic findings	Differentiating Laboratory findings
Fungal	Histoplasmosis	Mississippi and Ohio River valleys	Cave dwellers Soil that contains bird or bat dropping	Palate and oral ulcers Spleenomegaly	Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages	Pancytopenia Urine antigen testing
	Coccidioidomycosis	Southwestern US region	Opportunistic infection seen in AIDS	Rash on upper body or legs Night sweats	Characteristic spherule appearance	Serologic tests( enzyme immune assay )more sensitive
	Paracoccidioidomycosis	Central and South america	Opportunistic infection seen in AIDS	Lymphadenopathy Hepatosplenomegaly Bone marrow dysfunction	Smaller fungi with thin cell walls, forming mariner wheel appearance, circumferentially surrounding the parent cell.( Captain wheel appearance )	Elevated liver enzymes Hyperbilirubinemia Hypoalbuminemia
	Sporotrichosis	Ubiquitous	Gardeners	Person’s hand or the arm Lymphadenitis (nodular)	Finger or cigar shaped yeast.	Sporotrichin skin test
	Aspergillosis	Ubiquitous	Cystic fibrosis or asthma. tuberculosis. Immunocomprimised	Wheezing Stuffiness, runny nose Hemoptysis Weight loss	Septated hyphae with acute angle branching	Cell wall detection using galactomannan antigen detection, Beta-D-glucan detection test.
Bacterial	Anthrax	Ubiquitous	Live stock handlers	Painless skin ulcer with a black center Bloody diarrhea	Nonmotile, Gram-positive, aerobic or facultatively anaerobic, endospore-forming, rod-shaped bacterium	thrombocytopenia, hyponatremia, BUN, hypoalbuminemia, troponin.
	Legionella	Ubiquitous	Chronic lung disease Building water systems	Diarrhea Confusion	Gram negative bacterium	Urine Antigen + Hyponatreimia
	Tuberculosis	Asia,Africa	Ill contact individuals	Night sweats Hemoptysis	Acid fast bacteria
	Listeriosis	Ubiquitous	Pregnant women Adults > 65 Immunocomprimised.	pregnancy can lead to miscarriage, stillbirth, premature delivery, Non-pregnant : headache, stiff neck, confusion, loss of balance, and convulsions	flagellated, catalase-positive, facultative intracellular, anaerobic, nonsporulating, Gram-positive bacillus
	Brucellosis	Mexico, South and Central America	People who take unpasteurized dairy products	Arthritis Testicular and scrotal swelling Endocarditis	Gram-negative bacteria,non-motile, encapsulated coccobacilli.
	Scrub typhus	Asia-Pacific region Australia Afghanistan	Hikers	Maculopapular rash	a Gram-negative α-proteobacterium intracellular parasite
	Leptospirosis	Temperate, tropical climates.	People who with animals,	Jaundice Red eyes kidney failure	Spiral-shaped bacteria with hooked ends on dark-field.
	Cat scratch fever	Ubiquitous	cat licking a person's open wound, or bites or scratches a person	Lymphadenopathy papule or pustule at the infected site	Gram-negative bacteria. facultative intracellular parasites

Bacterial

Viral

Chronic and disseminated disease

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

References

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